Hidden Costs: The Economic Impact of Irritable Bowel Syndrome (IBS)
How can we measure the true costs of an illness, especially one as neglected as irritable bowel syndrome (IBS)? So many factors are at play. There are the intangible costs of decreased quality of life for patients and the direct personal financial expenses incurred from lost wages and expenditures for non-prescription health care products and special dietary needs. Add to this, the tangible healthcare system costs and the financial impact on employers. These dynamic interplays confound the economic burden calculations of irritable bowel syndrome.
In Canada, where we have publicly-funded medical care and, to a lesser degree, publically-funded medications, we can measure some costs by analyzing public databases, particularly if healthcare providers code all services in detail, including not only the prime reason for a medical service, but all the issues a patient brings forward during a visit.
Another complicating factor in measuring IBS costs lies in patient care-seeking behaviour. Some medical conditions still hold social taboos; they may not be the first thing someone reports to a physician, but they do come up during an office visit as a secondary concern, sometimes just in passing, or as an afterthought. However, these ‘afterthoughts’ could actually be the very thing that drives the initial office visit but may not be counted in statistics as the primary patient complaint.
The Numbers are Staggering
Many individuals don’t even get as far as asking for help. An estimated 90% of persons who suffer with symptoms of bloating, abdominal pain, diarrhea, and/or constipation don’t seek help for these life-affecting symptoms.1 Irritable bowel syndrome is one of the most common disorders, affecting 13-20% of Canadians, so of the estimated 4.3 million to 6.7 million Canadians who have IBS, up to 6 million are not getting help!
A condition not treated takes its toll too. IBS is a functional disorder of the digestive tract, meaning that there is no known organic disease found, yet the digestive system is definitely not functioning correctly. This factor in itself leads some to believe that there is no help available for IBS patients, but there is.
What is IBS Really Like?
Well, imagine not wanting to eat because you feel as if there is nothing you can eat that will not end up feeling uncomfortable or painful going through your body. Also, imagine what life is like for the person with persistent diarrhea, who has to map out every washroom along the road ahead before setting out, because of fear… fear of not making it to the toilet in time. The person with constipation, while not having to rush to the toilet, still spends agonizing time in the washroom, and can sometimes be in such pain, that staying home is the only thing within the realm of possibilities. The symptoms of bloating can change a person’s body so drastically throughout the day that clothing put on in the morning no longer fits in the evening. These are just some of the things a person with IBS could go through. While each person with this condition has a unique experience, it can range from being only minimally disruptive to being completely overwhelming.
What works for IBS?
Speak to your physician about these key modalities, which might work for you:
- dietary adaptation
- physical exercise increase
- other lifestyle modifications
- medications
Diminished Quality of Life
Not surprisingly, many IBS patients suffer an enormous impact on their quality of life due to the physically demanding symptoms and the difficulties of integrating work, school, family, and a further social life with the complexities of living with a chronic condition. Although you cannot necessarily tell just by looking at someone whether IBS symptoms are occurring, the ongoing pain and frustrations regarding bowel movements are significant. Many patients struggle to manage irritable bowel syndrome.
IBS patients report a quality of life that is comparable to that reported by patients with clinical depression, and both groups exhibit decreased levels of emotional health, social functioning, and mental health when compared to patients with some other chronic disorders.2 The findings from a large study, involving more than 125,000 subjects, indicate that patients with IBS are at increased risk for migraine, depression, and fibromyalgia, which is a chronic condition of fatigue, muscle pain, and other symptoms.3
Costs to the Healthcare System
In addition to the substantial impact on the intangible aspects of IBS patients’ lives, there are very real and direct economic costs associated with this condition, despite the fact that many of these individuals never seek direct medical care for the bowel symptoms. Economic consequences result from costs to the healthcare system for the diagnosis and management of IBS, and from the loss of productivity associated with absenteeism and ‘presenteeism,’ which is when someone is present at work or school but is performing at below usual efficiency, due to interfering influences.
IBS represents the most frequent diagnosis for those seeking the care of a gastroenterologist.4 Direct medical costs for care are broken down to the following: 46% for diagnostic testing, 12% for medication (over-the-counter and prescription), 10% for referrals to other medical professionals, and 9% for emergency room visits. In Ontario alone, these costs are estimated to reach $131 million annually.5 These substantial costs incur despite the fact that many patients cannot find symptom-free treatment and sufferers continue to endure varying symptom severity throughout their lives.
Costs from Lost Work
Since most IBS patients, even with a diagnosis, do not seek ongoing medical care for their symptoms, studies attempting to quantify the costs of this condition may underestimate its true economic burden. Researchers have attempted to correct this by studying very selective populations. One such study examined all the employee health claims over a two-year period for a large US corporation. The analysis showed that IBS patients cost this employer an average of $1,258 compared to non-IBS patients at $742.6
Research indicates that time lost from work or other impacts to performance are significant factors for IBS patients. In fact, this impact is so great that IBS is the cause of as much employee absenteeism as the common cold.7 IBS patients tend to miss work more often due to illness or to make time for physician visits and other medical care. One survey of US households found that those with IBS missed three times more work than did patients with no evidence of a functional gastrointestinal disorder.5
A four-week study of patients within both the UK and the US revealed similar results from both regions: an average of two days lost from work per month and a shortened workday 3 times a month. This study also showed a higher than average number of IBS patients reporting work impacts owing to their illness, as follows: 12-17% quit or lost their job, 9-18% changed job, 8-9% changed schedule, 15-19% worked fewer hours, 16-26% turned down a promotion, and 11-12% began working from home.4
Outlook
Irritable bowel syndrome is a disorder characterized by multiple impacts to an individual’s well being and the healthcare system overall, and involves substantial effect on the economy, as well as to each patient’s own financial security. This disorder too often goes under recognized, untreated, and without the attention it warrants, particularly given its prevalence and the associated significant health and economic implications. Research into new treatment and management strategies might lead to reducing these burdens. More importantly, as this area has been sorely underfunded, more efforts must be directed to understanding the cause of this condition, and finding cures.
Remember that donations to this registered charity help support education and research regarding gastrointestinal diseases and disorders, including IBS.