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. 2019 Jan 1:12:1756284818818326.
doi: 10.1177/1756284818818326. eCollection 2019.

Factors associated with more frequent diagnostic tests and procedures in patients with irritable bowel syndrome

Brian Lacy  1 , Rajeev Ayyagari  2 , Annie Guerin  3 , Andrea Lopez  2 , Sherry Shi  3 , Michelle Luo  4
Affiliations

Factors associated with more frequent diagnostic tests and procedures in patients with irritable bowel syndrome

Brian Lacy et al. Therap Adv Gastroenterol. .

Abstract

Background: Irritable bowel syndrome (IBS) reduces quality of life and burdens healthcare systems. This study identified factors associated with frequent use of IBS diagnostic tests and procedures.

Methods: Using a United States claims database (2001-2012), tests and procedures in IBS patients occurring in the 2-year study period (12 months before/following the first IBS diagnosis) were analyzed: endoscopy, GI transit testing, anorectal procedures, and radiologic imaging. Patients were classified based on test/procedure frequency (3+, 1-2, or 0). Multivariate logistic regression identified factors associated with more frequent tests/procedures.

Results: Among 201,322 IBS patients, 41.7% had 3+ tests/procedures, 35.1% had 1-2, and 23.3% had 0. Patients with more tests/procedures were older [mean age 50.6 (3+ group), more likely to be female and had more comorbidities, including anxiety, depressive disorders, and somatization. Dyspepsia [odds ratio (95% confidence interval): 1.80 (1.72-1.87)], interstitial cystitis [1.60 (1.45-1.77)], gastroesophageal reflux disease [1.59 (1.55-1.63)], constipation [1.50 (1.45-1.54)], and dyspareunia [1.38 (1.25-1.52)] were significantly associated with more tests/procedures (3+ versus 1-2), while anxiety, depressive disorders, and somatization were not. Patients with more frequent specialist visits [emergency department (ED; 1.10 (1.09-1.11)) and gastroenterologists (1.26 (1.26-1.27))] or at least one GI-related ED visit or inpatient admission [1.95 (1.86-2.04) and 3.67 (3.48-3.87), respectively] were more likely to have more tests/procedures (all p < 0.05).

Conclusions: Test frequency in patients with IBS is strongly associated with demographic and clinical characteristics, especially comorbid conditions related to IBS. Presence of common overlapping comorbid conditions should increase clinicians' confidence in making the diagnosis of IBS, thus curtailing redundant testing and reducing healthcare costs.

Keywords: claims analysis; diagnostic tests; irritable bowel syndrome; procedures resource use.

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Conflict of interest statement

Conflict of interest statement: BL is a scientific advisory board member with Takeda Pharmaceuticals, Ironwood, and Salix. RA, AG, and SS are employees of Analysis Group, Inc., and AL is a former employee of Analysis Group, Inc., which has received consultancy fees from Takeda Pharmaceuticals. ML is an employee of Takeda Pharmaceuticals and owns stock/stock options.

Figures

Figure 1.
Figure 1.
Sample selection of patients with IBS diagnosis in the United States. Patients in the high-count group had ⩾3 tests/procedures in the 2-year study period, those in the moderate-count group had 1–2 tests/procedures, and those in the zero-count group had no tests/procedures. IBS diagnosis was identified by a claim with ICD-9 code 564.1x. IBS, irritable bowel syndrome; ICD, International Classification of Diseases, ninth revision; N, number.
Figure 2.
Figure 2.
Number of diagnostic tests/procedures during the 2-year study period and definition of study cohorts. N, number.
Figure 3.
Figure 3.
Overall distribution and overlap of patients with IBS and GERD, interstitial cystitis, dyspepsia, and dyspareunia. All digits refer to the number of patients with a single or combination of overlapping comorbidities. GERD, gastroesophageal reflux disease; IBS, irritable bowel syndrome.
Figure 4.
Figure 4.
Interplay of factors that complicate the full diagnostic process for patients with IBS. IBS, irritable bowel syndrome.
See this image and copyright information in PMC

References

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