Ibs burden of illness
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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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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

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.


Key facts about ibs

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.


Key facts about ibs continued

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.


Prevalence of ibs diagnosis

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.


Burden of illness in ibs

Burden of Illness in IBS

Direct Medical Costs

Productivity Loss

Health Related Quality of Life


Direct medical costs associated with ibs

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.


Productivity burden us population

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.


What is hrqol

What is HRQOL?

Psychological

Physical

Multidimensional Construct

Social


Why measure hrqol

Why Measure HRQOL?

  • Physiologic endpoints  functional status and well-being

  • Can help define burden of disease

  • HRQOL outcomes matter to patients


Impact of ibs on quality of life compared with us norms

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.


Impact of ibs on quality of life compared with other medical conditions

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.


Ibs burden of illness

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.


Hrqol and burden of disease in ibs gralnek im et al gastroenterology 2000 in press

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


Hrqol and burden of disease in ibs

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


Ibs burden of illness

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)


Ibs burden of illness

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)


Ibs burden of illness

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)


Sf 36 physical component summary scores

SF-36 Physical Component Summary Scores

*

*

*

*

* P < 0.002 - Significantly different from IBS

Gralnek IM et al., Gastroenterology, 2000 (In Press)


Sf 36 mental component summary scores

SF-36 Mental Component Summary Scores

*

*

*

*

*

* P < 0.002 - Significantly different from IBS

Gralnek IM et al., Gastroenterology, 2000 (In Press)


Ibs burden of illness1

IBS Burden of Illness

Significant Disease Burden

  • Increased Direct Medical Costs

  • Reduced Productivity

  • Impact on Quality of Life


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