IBS Treatment Is More Effective and Less Costly in the Primary Care Setting

A Dutch study in BMC Gastroenterology has found that treatment for irritable bowel syndrome (IBS) is significantly more expensive when treated in secondary care settings than it is when treated in primary care settings -- without a corresponding increase in treatment effectiveness.

The finding is important, because IBS patients are typically high utilizers of health care services. In the United States, estimates indicate that IBS treatment is responsible for more than $1.3 billion in health expenditures. Many cases of IBS resist simple diagnosis and treatment, because the condition is characterized by what the researchers call “patterns of persistent bodily complaints for which a thorough diagnostic workup does not reveal adequate explanatory structural pathology.” Thus, they argue, detailed insight into the specific health care costs of treating IBS is needed to determine the overall societal impact of the disease and assess different treatment strategies in different settings.

“Although guidelines suggest that in the absence of alarm symptoms, the majority of IBS patients can be adequately managed in primary care, there are substantial differences in referral rates across Europe, ranging from 10 % in the Netherlands to 44 % in the UK,” the researchers observed. “If disease-related medical costs for IBS management substantially differ between primary and secondary care, variation in referral rates will have important economic consequences.”

The study found that the care setting does, indeed, make a big difference in cost. Reimbursement data for patients diagnosed with IBS by a general practitioner (GP) or specialist between 2006 and 2009 were extracted from a healthcare insurance company and compared to an age and gender matched control group of patients without IBS. Looking at nearly 10,000 records, the researchers found that total healthcare costs per patient substantially increase after a diagnosis of IBS and IBS related costs are significantly higher when patients are treated in secondary-care compared to primary-care.

Total health care costs for IBS patients increased substantially in the years after the diagnosis, 29% for primary and 116% for secondary care patients. “The increase in costs related to hospital specialist care for secondary care patients is, for the most part, due to costs for other chronic disorders (+80 %) and ‘all other disorders’ (+124 %),” the researchers observed. “We hypothesise that gastroenterologists are more likely to refer IBS patients to other hospital specialists than [general practitioners] (GPs), thus explaining the differences in increased costs. In the Netherlands, as in many other countries with a strong primary care, the GP as acts as the ‘case manager ‘of the patient, coordinating the diagnostic and treatment process. The longitudinal relation with the patient and the knowledge of medical history and psychosocial system facilitates an integral approach to IBS , and helps to prevent unnecessary referral and diagnostic procedures. This benefits both disease outcome, and patient’s quality of life and reduces health care costs.”

The study authors conclude that IBS patients should be treated in primary care settings whenever possible, with referrals restricted for cases that include alarm symptoms, ill-matching symptoms, or other cases of diagnostic uncertainty.

Notably, the researchers tackled the idea that there is a difference in IBS symptom severity and disease impact between patients attending primary and secondary care, which explains the increased costs. “Our results demonstrate that the difference in costs between primary and secondary care is not so much due to direct IBS related costs but due to costs for other disorders,” they said.