2011 Managing IBS In The Community: The financial Burden And The Way Forward

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Focus April 11

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Irritable Bowel Syndrome | Hot Topic

Managing Irritable Bowel Syndrome in the Community: The financial burden and the way forward Marianne Williams, BSc Hons, RD, Specialist Allergy & IBS Dietitian

Introduction Irritable Bowel Syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder. Recent research has suggested that at least ten per cent of the United Kingdom population suffer from IBS1 with annually 2.34 million people seeking advice from a general practitioner.2, 3 This constitutes a significant healthcare cost and highlights the enormity of IBS as a UK health issue. This article will discuss the costs of managing IBS in the community, along with diagnosis and dietetic treatment, and present solutions to improve the management of this patient group.

Cost implications As long ago as 1997, Wells et al estimated that the treatment of IBS cost the UK NHS £45.6 million annually4 including inpatient, outpatient care, diagnostic and therapeutic procedures, laboratory tests and rehabilitation. This was a tremendous cost at around 0.1 per cent of the total NHS spend for what was then still seen as a fairly obscure disease. In 2006, Maxion-Bergemann et al 5 reviewed the costs of IBS in the UK and US and used data which compared IBS costs to those of matched controls. They showed that costs incurred by IBS patients for outpatient appointment, GP visits and costs for medications were significantly higher. Seventy-five per cent of IBS patients in the UK used a prescription drug to treat their IBS, with many medications being prescribed for over 100 days. Although both the 2008 NICE report on IBS6 and the 2010 NHS Economic Report: Value of calprotectin in screening out irritable bowel syndrome,7 clearly suggested diet as a first line treatment for IBS, local GPs report that they are inadequately trained in the use of IBS diagnostic criteria and have little knowledge of the new dietary approaches now available for this condition. However, one in 12 GP consultations are based around gastrointestinal problems with 46 per cent being diagnosed as having IBS. This equates to a full-time GP seeing eight patients per week with IBS as their main complaint.8 Presently, GPs often refer for costly specialist consultations and/or prescribe a number

of drugs.2 Education of GPs by dietitians would seem essential. Indeed, Bellini states that: “If GPs have an adequate understanding of IBS they will be better able to diagnose and manage the syndrome and expenditures for possibly useless tests and treatments can be avoided.”2 What became apparent when reviewing the data on costs was that referrals into secondary care formed a significant financial burden with research papers suggesting that between 20 per cent8 and 31 per cent2 of IBS patients will undergo invasive secondary care investigations. In 2010, at a Clinical Engagement Event, held at Guys & St Thomas’s NHS Foundation Trust (GSTT) in London, it was noted that IBS outpatient referral to secondary care cost is in the region of £250 per person and that: “90 per cent of patients referred by primary care to gastroenterology would end up having some sort of endoscopic procedure.” 9 This must raise financial cause for concern and possibly highlight an urgent need for primary care IBS diagnosis and treatment education. The national tariffs for referrals, investigations and suggested treatments are listed in Table One. It is clear to see from this table that replacing visits and investigations into secondary care with dietetic treatment could significantly reduce the total cost burden of IBS, although I would question the use of a Band 5 dietitian: the responsibility and level of academic knowledge required to run a dietetic-led IBS clinic would realistically demand a specialist or advanced dietitian at band 6 or 7.

Table One: National Tariffs for Referrals, Procedures and Treatments Resource/Treatment10 GP visit

£36.00

Nurse visit

£11.00

Specialist visit

£188.81

IBS medication*

£17.22

Dietitian (hourly rate)**

£24.29

Psychological intervention (hourly rate)

£41.55

Procedure10 Colonoscopy

£544.45

Sigmoidoscopy

£365.59

Treatments

3

Dietitian with 3 1-hour sessions** £73.00 Resource/Treatments10 Tricyclic antidepressants annually

£21.13

Serotonin reuptake inhibitors annually

£25.73

Psychological therapy with 7 sessions @ £41.55

£291

* Based soley on the use of Mebeverine (antispasmodic) ** Based on referral to band 5 dietitian at the time of reference publication

CN Focus Vol.3 No.1 April 2011 | 27


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