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Health-Related Quality of Life and Health Care Costs in Severe, Refractory Irritable Bowel Syndrome

Francis Creed, FRCP, F.Med Sci; Joy Ratcliffe, MRCPsych; Lakshmi Fernandez, MRCPsych; Barbara Tomenson, MSc; Steve Palmer, MSc; Christine Rigby, MSc; Elspeth Guthrie, MD, MRCPsych; Nicholas Read, MD, FRCP; and David Thompson, FRCP, F.Med Sci
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From University of Manchester School of Psychiatry and Behavioural Science and Hope Hospital, Manchester; Belmont Day Hospital, Bolton; St. George's Community Health and Northern General Hospital, Sheffield; Centre for Health Economics, York; and Mental Health Services of Salford, Salford, United Kingdom. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Acknowledgments: The authors thank the Medical Research Council for financing the study, the Health Authorities for financing the psychotherapists, the patients who consented to take part in the trial, and the physicians who prescribed the antidepressant medication.

Grant Support: By Medical Research Council (grant G9413613) and North West Region Health Authority Research and Development Directorate.

Requests for Single Reprints: Francis Creed, FRCP, F.Med Sci, School of Psychiatry and Behavioural Science, Rawnsley Building, Oxford Road, Manchester M13 9WL, United Kingdom; e-mail, francis.creed@man.ac.uk.

Current Author Addresses: Dr. Creed, Ms. Tomenson, and Dr. Guthrie: School of Psychiatry and Behavioural Science, Rawnsley Building, Oxford Road, Manchester M13 9WL, United Kingdom.

Dr. Ratcliffe: Belmont Day Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR, United Kingdom.

Dr. Fernandez: St. George's Community Health, Winter Street, Sheffield S3 7ND, United Kingdom.

Mr. Palmer: Centre for Health Economics, Heslington, York YO1 5DD, United Kingdom.

Ms. Rigby: Mental Health Services of Salford, Meadowbrook, Stott Lane, Salford M6 8HG, United Kingdom.

Dr. Read: Centre for Human Nutrition, Northern General Hospital, Herries Road, Sheffield, S5 AU, United Kingdom.

Dr. Thompson: G.I. Science, Hope Hospital, Eccles Old Road, Salford M6 8HD, United Kingdom.

Ann Intern Med. 2001;134(9_Part_2):860-868. doi:10.7326/0003-4819-134-9_Part_2-200105011-00010
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Background: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder.

Objective: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs.

Design: Cross-sectional survey.

Setting: Secondary and tertiary gastroenterology clinics.

Patients: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment.

Measurements: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses.

Results: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean (±SD) Hamilton depression score was 11.3 ± 6.1. The SF-36 physical component summary score was low (37.7 ± 10.6), and the patients had incurred high health care costs ($1743 ± $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted R2 = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R2 = 9.3%). History of sexual abuse was not an independent predictor of outcome.

Conclusions: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.


Grahic Jump Location
Figure 1.
Postulated relationships between predictors and outcomes.

SCL-90 = Symptom Checklist 90.

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Figure 2.
Subscale scores on Short-Form 36-item questionnaire (SF-36) for patients with the irritable bowel syndrome (IBS) in the current study, patients in the Medical Outcomes Study with serious medical illness and concurrent psychiatric disorders(21), and the general population.

E = emotional; P = physical.

Grahic Jump Location




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