The Costly Toll of Irritable Bowel Syndrome
The effect of living with the ongoing symptoms of irritable bowel syndrome (IBS) significantly reduces quality of life (QOL) for many sufferers. This challenging disease also has a noteworthy social impact because it is such a widespread medical condition.
For many years, IBS did not garner recognition as a legitimate illness and research funds were scarce. However, some recent assessments by researchers examining issues surrounding IBS have exposed its costly toll. For example, people with IBS have a lower QOL than patients with reflux disease (GERD), asthma, and migraine headaches; were comparable to patients with type 2 diabetes and end stage renal disease; and yet have a higher QOL than patients with depression, panic disorder, and rheumatoid arthritis.
In the Western world, IBS prevalence is high, ranging from 6-22%. Despite the significant symptoms of this disorder, which include cramping, abdominal pain, bloating, constipation, and/or diarrhea, IBS receives little attention compared with less prevalent conditions. This may be due to the nature of IBS symptoms or because only 22-50% of people with these symptoms actually consult a doctor. Those who do see a doctor wait an average of ten years before doing so, and women consult more frequently than men. QOL varies significantly from patient to patient with IBS.
How we individually define QOL depends on many things. The World Health Organization defines QOL as, “The individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. It is a broad-ranging concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs, and relationship to salient features of the environment.”
IBS-related physician visits, adjusted for prevalence, occur at approximately the same rate as visits for asthma and migraine headaches. Not counting prescription and over-the-counter medications, it is estimated that more than $30 billion is spent annually on IBS in the US, where most of the data originates.
This estimation comprises both direct costs, the measurable uses of healthcare resources, and the indirect costs from productivity losses in the workplace – borne by the employer – due to missed days from work (absenteeism) and decreased work efficiency (presenteeism). At least one third of IBS employees miss an average of one day of work per month due to their IBS symptoms and have reported, via various surveys, a 15-21% greater loss in work productivity because of gastrointestinal symptoms than employees without IBS.
In 1992, IBS was the second leading cause, behind the common cold, of workplace absenteeism, and recent data suggest that the gap may be shrinking. In a study of 2,143 patients with IBS in the US and eight European countries, those with IBS reported missing an average of 4 to 10.9 days of work during the previous year compared with 1.5 to 5.6 days reported by control subjects. By way of comparison, a recent analysis concluded that affected workers lost roughly 1 day of work (9 hours) per common cold episode. Another survey found that 67% of adults experience at least 1 cold per year and that among those adults the average is 2.2 cold episodes per year.
IBS symptoms restrict or otherwise negatively impact many aspects of patients’ lives, including diet, travel, sleep, intimacy, and leisure activities. Patients with IBS report that symptoms often cause them to be late for work or to leave work early. Because of their IBS symptoms, many have made job decisions they would not otherwise have made, such as cutting back on days of work, working fewer hours, turning down promotions or advancements, and working from home. One survey showed that 47% of respondents had not informed their employers of their diagnosis because of the nature of IBS symptoms and the fact that some employers do not accept these symptoms as valid reasons for work absence.
IBS is a long-term, episodic gastrointestinal motility disorder that is prevalent among adults of working age. It imposes a substantial burden on patients and employers. Although IBS can be confidently diagnosed based on characteristic symptoms, it is often misdiagnosed or under-recognized by patients and physicians, leading to multiple physician visits, multiple medications, and unnecessary diagnostic tests, procedures, and surgeries – all of which contribute to higher direct medical costs.
Additionally, employers incur significant costs because of IBS-related absenteeism and presenteeism. Such costs have traditionally been difficult to quantify, but recent efforts have led to better understanding of their magnitude.
Some jurisdictions successfully use educational awareness programs to reduce the costs associated with other long-term disorders; and the researchers suggest that with appropriate implementation, such programs might have similar results for IBS.