Irritable bowel syndrome: Toward a cost-effective management approach

Objective: To examine the economic implications of current irritable bowel syndrome (IBS) management practices and formulate recommendations based on these implications. Methods: Relevant English-language research publications in which the direc t and indirect costs of IBS were examined, identified using a search of rec ords contained in Medline. Results: Review of the identified publications indicates that in Western na tions, IBS management is associated with high direct costs (particularly fo r diagnostic testing, office visits, pharmacotherapy, and emergency departm ent visits). Indirect costs, associated with lost wages and decreased produ ctivity, account for the largest proportion of the]BS economic burden. More over, rapid projected growth in IBS disease-related costs indicates a need for more focused attention toward improved treatment of IBS. More cost-effe ctive management might be achieved by diagnosing and instituting nonpharmac ologic and pharmacologic management earlier in the disease process. Under s uch an approach, patients are classified based on symptoms and a therapeuti c trial is begun. More extensive, expensive diagnostic testing is reserved for patients refractory to treatment or for whom serious disease must be ru led out. Conclusion: IBS is a condition with high direct and indirect costs. Managem ent strategies should be evaluated both on their clinical efficacy and on t heir cost effectiveness. As new,]BS-specific pharmacotherapies become avail able, the ability to diagnose and manage the condition in a cost-effective manner can be improved.