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IBS Burden of Illness

IBS Burden of Illness. Ian M. Gralnek, MD, MSHS Director, UCLA Center for the Study of Digestive Health Care Quality and Outcomes Department of Medicine University of California at Los Angeles. Hallmark Symptoms of IBS. Chronic or recurrent GI symptoms lower abdominal pain/discomfort

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IBS Burden of Illness

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  1. IBS Burden of Illness Ian M. Gralnek, MD, MSHS Director, UCLA Center for the Study of Digestive Health Care Quality and Outcomes Department of Medicine University of California at Los Angeles

  2. Hallmark Symptoms of IBS • Chronic or recurrent GI symptoms • lower abdominal pain/discomfort • altered bowel function (urgency, altered stool consistency, altered stool frequency, incomplete evacuation) • bloating • Not explained by identifiable structural or biochemical abnormalities Reference: Thompson et al. Gut. 1999;45(suppl 2):1143-1147.

  3. Key Facts About IBS • 4-20% of the US population report symptoms consistent with IBS1,2 • Affects predominantly females (~70% of sufferers)3 • Can cause great discomfort, sometimes intermittent or continuous, for many decades in a patient’s life4 • Can significantly disrupt daily life5 References: 1. Drossman et al. Dig Dis Sci 1993;38(9):1569-80. 2. Talley et al. Am J Epid 1995;142:76-83 3. Sandler. Gastroenterology. August 1990;99:409-415. 4. Hahn et al. Dig Dis Sci. December 1998;43:2715-2718. 5. Hahn et al. Digestion. 1999;60:77-81.

  4. Key Facts About IBS (continued) • Treatment options1 • dietary modification • fiber supplements • pharmacologic agents • Success of treatment options in addressing multiple symptoms of IBS has been limited2 References:1. Drossman. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 2. Klein. Aliment Pharmacol Ther. 1988;13(suppl 2):15-30.

  5. Prevalence of IBS Diagnosis IBS Other GI 15% IBS 12% 28% IBD 14% Other Functional 13% Other 88% Peptic 20% Liver 10% Primary Care Practice1 Gastroenterology Practice2 References:1. Everhart et al., Gastroenterology, 1991:100; 998-1005. 2. Mitchell et al., Gastroenterology, 1987; 92:1282-4.

  6. Burden of Illness in IBS Direct Medical Costs Productivity Loss Health Related Quality of Life

  7. Direct Medical Costs Associated with IBS • IBS sufferers incur 74% more direct healthcare costs than non-IBS sufferers1 • Extrapolated to US population; IBS results in upward of $8 billion in direct medical costs annually1 • IBS patients have more physician visits for both GI and non-GI complaints2 References:1.Talley et al. Gastroenterology. December 1995;109:1736-1741. 2. Drossman et al. Dig Dis Sci. September 1993;38:1569-1580.

  8. 14 12 10 8 P=0.0001 Days per year 6 4 2 0 IBS (n=606) Control (n=1625) Productivity Burden(US Population) Absenteeism from work or school during the last 12 months Reference:Drossman et al. Dig Dis Sci. September 1993;38:1569-1580.

  9. What is HRQOL? Psychological Physical Multidimensional Construct Social

  10. Why Measure HRQOL? • Physiologic endpoints  functional status and well-being • Can help define burden of disease • HRQOL outcomes matter to patients

  11. Impact of IBS on Quality of Life Compared with US Norms 100 90 80 US Norm 70 Mean SF-36 score IBS 60 50 40 30 PhysicalFunctioning Role-Physical Bodily Pain General Health Vitality Social Functioning Role-Emotional Mental Health Adapted from Wells et al. Aliment Pharmacol Ther. 1997;11:1019-1030.

  12. Impact of IBS on Quality of Life Compared with Other Medical Conditions 100 90 Diabetes type II 80 US Norm 70 Mean SF-36 score 60 IBS 50 Clinical depression 40 30 PhysicalFunctioning Role-Physical Bodily Pain General Health Vitality Social Functioning Role-Emotional Mental Health Adapted from Wells et al. Aliment Pharmacol Ther. 1997;11:1019-1030.

  13. Impact of IBS on Quality of Life Compared with Other Medical Conditions CHF Mean SF-36 Score IBS PhysicalFunctioning Role-Physical BodilyPain General Health Social Functioning Role-Emotional Mental Health Vitality Whitehead et al., Dig Dis Sci, November 1996; 41:2248-2253.

  14. HRQOL and Burden of Disease in IBSGralnek IM et al., Gastroenterology, 2000 (In Press) AIM: To compare the impact of IBS on patients’ quality of life with that previously observed in the general population and in selected chronic diseases • 877 adult IBS patients meeting Rome criteria or ≥3 Manning criteria • Administered the SF-36

  15. HRQOL and Burden of Disease in IBS • Compared to SF-36 data in the general population and in patients with chronic diseases • GERD • End-Stage Renal Disease • Diabetes • Clinical Depression • Adjusted for Age and Gender • Adjusted for Multiple Comparisons

  16. US Pop. (n = 2474) Mean SF-36 Score IBS (n = 877) *p<0.001 Vitality* PhysicalFunctioning* Role-Physical* BodilyPain* General Health* Social Functioning* Role-Emotional* Mental Health* HRQOL in IBS Patients is Significantly Worse Compared to U.S. Population Gralnek IM et al., Gastroenterology, 2000 (In Press)

  17. HRQOL in IBS Patients is Significantly Worse Compared with GERD GERD (n = 516) IBS (n = 877) Mean SF-36 Score *p<0.001 Vitality* PhysicalFunctioning Role-Physical* General Health* Social Functioning* Role-Emotional* Mental Health* BodilyPain* Gralnek IM et al., Gastroenterology, 2000 (In Press)

  18. HRQOL in IBS Patients Compared with Other Diseases Diabetes (n = 541) ESRD (n = 165) IBS (n = 877) Mean SF-36 Score Depression(n = 502) PhysicalFunctioning Role-Physical BodilyPain General Health Vitality Social Functioning Role-Emotional Mental Health Gralnek IM et al., Gastroenterology, 2000 (In Press)

  19. SF-36 Physical Component Summary Scores * * * * * P < 0.002 - Significantly different from IBS Gralnek IM et al., Gastroenterology, 2000 (In Press)

  20. SF-36 Mental Component Summary Scores * * * * * * P < 0.002 - Significantly different from IBS Gralnek IM et al., Gastroenterology, 2000 (In Press)

  21. IBS Burden of Illness Significant Disease Burden • Increased Direct Medical Costs • Reduced Productivity • Impact on Quality of Life

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