The Humanistic and Economic Burden of Chronic Idiopathic Constipation in the USA: A Systematic Literature Review

Abstract

Background: Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder with an estimated prevalence of 16% in the USA; however, the humanistic and economic burden of CIC is poorly characterized.

Aim: This systematic literature review aimed to assess the humanistic and economic burden of CIC in adults in the USA.

Methods: Two systematic literature searches of English-language publications on the humanistic and economic burden of CIC in adults in the USA were conducted using electronic databases and other resources. Both searches included the terms "chronic idiopathic constipation" and "functional constipation". Specific terms used in the search on humanistic burden included "quality of life", "SF-36", "SF-12", and "PAC-QOL"; search terms for economic burden included "cost", "resource use", "absenteeism", and "productivity".

Results: Overall, 16 relevant articles were identified. Health-related quality of life (HRQoL) appeared to be reduced in patients with CIC compared with controls and the general US population. Abdominal (r=0.33-0.49), stool (r=0.23-0.33), and rectal symptoms (r=0.53) appeared to be associated with reduced HRQoL. Younger age and female sex were associated with reduced overall HRQoL and greater symptom severity. Direct outpatient costs were higher in patients with CIC than those without CIC (US$6284 vs US$5254). Patients with CIC and abdominal symptoms reported more days of disrupted productivity per month than those without abdominal symptoms (3.2 days vs 1.2 days). The overall prevalence of complementary and alternative medicine use by patients with CIC was similar to that in the general US population.

Conclusion: The reduced HRQoL and increased costs associated with CIC indicate unmet therapeutic need in this disorder. Further research is required to better understand the humanistic and economic burden of CIC in the USA.

Keywords: chronic idiopathic constipation; economic burden; functional constipation; health-related quality of life.

Figure 1

PRISMA flow diagram of study selection for articles reporting the humanistic burden of CIC in the USA. Abbreviations: CIC, chronic idiopathic constipation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Mean adjusted SF-36 component scores for patients with CIC and age- and sex-matched individuals without CIC in the USA. Notes: *p<0.05, **p<0.01 versus patients with CIC. Scores are adjusted for comorbidities. Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Quality of Life Research, The impact of functional constipation on quality of life of middle-aged black Americans: a prospective case-control study, Friedenberg FK, Dadabhai A, Palit A, Sankineni A, Copyright © (2012). Abbreviations: CIC, chronic idiopathic constipation; SF-36, 36-item Short-Form Health Survey

Figure 3

PAC-SYM and PAC-QOL scores in patients with CIC, stratified by (A) age and (B) sex. Notes: ***p<0.001 versus patients ≥60 years old. ^†p<0.05; ^††p<0.01; ^†††p<0.001 versus men. Data from Nojkov et al. Abbreviations: CIC, chronic idiopathic constipation; PAC-QOL, Patient Assessment of Constipation Quality of Life questionnaire; PAC-SYM, Patient Assessment of Constipation Symptoms questionnaire.

Figure 4

Flow diagram of study selection for articles reporting the economic burden of CIC in the USA. Abbreviations: CIC, chronic idiopathic constipation; CINAHL, Cumulative Index of Nursing and Allied Health Literature; SLR, systematic literature review.

Figure 5

Mean predicted costs (2007–2008) for patients with CIC and age- and sex-matched controls. Notes: *p<0.05. Data from Herrick et al. Abbreviations: CIC, chronic idiopathic constipation; ER, emergency room.