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Direct Costs for Treatment of Digestive Diseases

Somnath Pal, BS (Pharm), MBA, PhD
Professor of Pharmacy Administration
College of Pharmacy & Allied Health Professions
St. John's University
Jamaica, New York



12/17/2010

US Pharm. 2010;35(12):10.

According to the National Institutes of Health, 60 to 70 million people suffered from digestive diseases (DDs) in 2004. DDs led to 105 million ambulatory care visits, 14 million hospitalizations, 6 million diagnostic and therapeutic inpatient procedures, and 20 million ambulatory surgical procedures, at a cost of $142 billion. The direct medical cost of DDs was $98 billion, with $44 billion (44%) being expended for the top 10 DDs.

Ambulatory care settings were used by 35% of patients with DDs. The total cost of ambulatory care (excluding surgery) for DDs was $16 billion. In 2004, the largest number of ambulatory care visits was for gastroesophageal reflux disease (GERD) (18.3 million), followed by chronic constipation (6.3 million); abdominal-wall hernia (AWH) (4.7 million); diverticular disease (3.2 million); hemorrhoids (3.2 million); irritable bowel syndrome (IBS) (3 million); hepatitis C (2.7 million); liver disease (2.3 million); gastrointestinal infections (2.3 million); gallstones (1.8 million); peptic ulcer disease (PUD) (1.4 million); inflammatory bowel disease (IBD) (1.1 million); and pancreatitis (881,000). Direct medical costs included expenditures for hospital or physician services, drugs, nursing home or home health care (HHC), hospice care, and outpatient endoscopy.

Diseases costing more than $1 billion in hospital services were (in descending order) gallstones, AWH, diverticular disease, pancreatitis, colorectal cancer, appendicitis, liver disease, GERD, and PUD. Total physician charges associated with hospital services for DDs were $15 billion.

DD was more frequently the underlying cause of death than a contributing factor, mainly because of the high rate of cancer mortality. There was a 20% decline in DD mortality between 1979 and 2004, with cancer mortality being the greatest determinant (24%).

Drug Costs: The total cost of drugs prescribed for DDs was $13 billion. Of this, $7.7 billion was associated with drugs for GERD; PUD, hepatitis C, IBS, and IBD were major contributors to the remaining cost. OTC products for GERD, constipation, and diarrhea cost $2 billion, according to the Consumer Healthcare Products Association. Five types of proton pump inhibitor dominated the prescription market, at 51% of total number of prescriptions and 77% of total cost.

Cost by Type of Care: Nursing home care for patients with DDs cost $3.3 billion. The conditions that contributed the most to this sum were GERD, chronic constipation, diverticular disease, PUD, and colorectal cancer. Colorectal cancer, Crohn's disease, and pancreatic cancer were the biggest contributors to the $3.1 billion incurred in HHC settings for DDs. Hospice care for patients with DDs cost $1.9 billion; colorectal, pancreatic, and gastric cancers were the most expensive. Outpatient endoscopy for DDs cost $3.7 billion.

To comment on this article, contact rdavidson@uspharmacist.com.

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