DDW: Constipation Costs May Be Straining the Health Care System

WASHINGTON, May 24 -- Patients with constipation may be costing the health care system thousands of extra dollars per person each year as they struggle with co-morbidities and wrack up doctor visits, investigators suggested.

Average annual health care costs for California Medicaid patients with chronic constipation climbed from about ,500 in 1997 to just under ,000 in 2002, said Richard Brook, M.S., of The JeSTARx Group, a medical marketing and communications company in Newfoundland, N.J., and Robert Baran, PharmD, of Takeda Global Research and Development in Deerfield, Ill.

During the same time period, the health care costs of age- and gender-matched controls actually decreased slightly, from about ,800 to about ,200, the investigators reported at Digestive Disease Week.

The marked difference suggests several explanations, Mr. Brooks said. One is that constipation is associated with substantial co-morbidities.

Another may be that patients are returning to their doctors repeatedly when treatments fail. Evidence for this explanation includes the fact that outpatient health care costs, which include physician visits, increased the most from 1997 through 2003 - from an average of about ,500 annually to nearly ,000, he said. Costs for controls during this period decreased slightly, from to .

Yet another explanation for increased costs, Mr. Baran suggested, may be that older individuals with constipation may be institutionalized or sent to an assisted living facility at a greater rate than those without constipation. He noted that bowel problems are one of the chief criteria for being sent to a nursing home or other such facility.

Drug costs for the constipation group also increased substantially, from an annual average of about ,000 in 1997 to more than ,000 in 2003, the investigators found. For the control group, the increase during that time period was from to .

The study retrospectively analyzed data from California Medicaid (Medi-Cal) pharmacy and medical claims for a random sample of more than 23,000 individuals newly diagnosed with constipation. The study included only individuals with an ICD-9 diagnosis code for constipation.

For each subject with constipation, the study used five controls matched by age, gender, and institutionalized status.

The investigators also found evidence that constipation is no longer a predominantly age-associated, female condition. The average age of patients at first diagnosis steadily decreased from 64.5 in 1997 to about 56 in 2003, they found. In addition, the percentage of patients newly diagnosed with constipation who were female decreased during the same time period from 66% to 60%.

The reason, they speculated, is likely increasing awareness of the condition and less stigma attached to it.