Irritable bowel syndrome: toward a cost-effective management approach.

OBJECTIVE: To examine the economic implications of current irritable bowel syndrome (IBS) management practices and formulate recommendations based on these implications.
METHODS: Relevant English-language research publications in which the direct and indirect costs of IBS were examined, identified using a search of records contained in Medline.
RESULTS: Review of the identified publications indicates that in Western nations, IBS management is associated with high direct costs (particularly for diagnostic testing, office visits, pharmacotherapy, and emergency department visits). Indirect costs, associated with lost wages and decreased productivity, account for the largest proportion of the IBS economic burden. Moreover, rapid projected growth in IBS disease-related costs indicates a need for more focused attention toward improved treatment of IBS. More cost-effective management might be achieved by diagnosing and instituting nonpharmacologic and pharmacologic management earlier in the disease process. Under such an approach, patients are classified based on symptoms and a therapeutic trial is begun. More extensive, expensive diagnostic testing is reserved for patients refractory to treatment or for whom serious disease must be ruled out.
CONCLUSION: IBS is a condition with high direct and indirect costs. Management strategies should be evaluated both on their clinical efficacy and on their cost effectiveness. As new, IBS-specific pharmacotherapies become available, the ability to diagnose and manage the condition in a cost-effective manner can be improved.