Comparing Cost, Outcomes of IBS-D Treatments


In this podcast, Eric D. Shah, MD, MBA, speaks about his team's study that analyzed the cost-benefit outcomes for patients with IBS-D and how their findings can impact clinical practice when choosing the best treatment for patients. 

For more IBS-D content, visit the Resource Center.

Additional Resource: 

  • Shah ED, Salwen-Deremer JK, Gibson PR, Muir JG, Eswaren S, Chey WD. Comparing costs and outcomes of treatments for irritable bowel syndrome with diarrhea: cost-benefit analysis. Clin Gastroenterol Hepatol. 2022;20(1):136-144.e31. doi:10.1016/j.cgh.2020.09.043.

Eric D. Shah, MD, MBA, is the director of the Center for Gastrointestinal Motility, Esophageal, and Swallowing Disorders at Dartmouth University (Hanover, NH). 


Jessica Ganga: Hello, everyone and welcome to another installment of Podcast360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Ganga, with Consultant360, a multidisciplinary medical information network. The economic burden of irritable bowel syndrome for patients in the United States collectively is about $1.5 billion to $10 billion per year, which does not include the cost of prescription and over-the-counter medications, according to the American College of Gastroenterology. Here to speak with us today about the high cost of IBS is Dr. Eric Shah, who is the Director of the Center for Gastrointestinal Motility, Esophageal and Swallowing Disorders at Dartmouth University in New Hampshire. Thank you for joining us today. Dr. Shah. Please give us a brief overview of your study comparing cost and outcomes of treatments for irritable bowel syndrome with diarrhea cost-benefit analysis.

Dr Eric Shah:  IBS-D, or diarrhea-predominant IBS, is very common. It accounts for about half of the patients that we see in gastroenterology. IBS affects about 30 to 40% of patients across the US. One of the most common problems that gastroenterologists face is the burden of prior authorizations, denials, and patients who need help but can't afford their drugs. To date, we haven't had much data to help guide medical decisions on what treatments we should be choosing upfront. To address these barriers, we conducted a study that pulled in clinical outcomes and costs data to understand what might be driving divergent treatment preferences between insurance and patient perspectives on a daily basis.

JG: Can you tell us more about how this cost-benefit analysis came about?

Dr Shah: Absolutely. This study came about from the pragmatic realities of checking our electronic inboxes or looking in our mailboxes and just seeing a stack of denials.

JG: From the study, what were the findings and did anything surprise you?

Dr Shah: Definitely. We found that on-label prescription drugs are more expensive than off-label treatments, and this can lead to the insurance companies recommended off-label treatments. and denying access due to cost. That said, there are inflection points at which drugs become cost-effective for many patients.

Beyond that, there are several behavioral options (such as cognitive behavioral therapy) and dietary options (such as a low FODMAP strategy) that patients can try. Insurers would prefer that patients don't take drugs due to their cost. But, this preference may not hold true among patients. For example, we learned that the cost of food is very important to considering a dietary management strategy for chronic disease. Another example is the need to attend multiple visits to see a therapist or psychologist. These are things that the gastroenterologist might not realize on a day-to-day basis, so our study helped identify specific talking points that can help patients understand their options and engage with the best one that meets their needs.

JG: That's a great segue into the next question that I have, is how might these findings impact clinical practice?

Dr Shah: From a policy standpoint, prior authorizations remain a challenge. The intended purpose of prior authorizations was to nudge providers away from low-value treatments or procedures and toward high-value opportunities. The problem now is a lot of drugs just live under the prior authorization umbrella. In a separate study, we published a national survey among members of the American College of Gastroenterology in which respondents indicated that they stopped considering treatments that they would prefer altogether because of the burden of prior authorizations. This is a major policy issue. And here, we have some data to help back up how prior authorizations and healthcare costs affect all sides.

How can we solve these problems? Healthcare is expensive. And, leaving disease untreated is expensive and not the right thing for our patients. Learning how to have a conversation about costs with patients in daily practice, and developing datasets to help physicians, patient advocacy groups, insurers, industry, and policymakers understand costs are necessary to make progress.

JG: What are the gaps in the research of IBS-D?

Dr Shah: We have so much clinical data on treatments for IBS-D. On the cost side, we now are beginning to understand the importance of relative treatment costs including money as well as time that are important to choosing the right treatment for IBS-D. By this, I mean the costs of food, the opportunity cost of losing time away from work, family, and self, and other costs such as transportation and childcare.

JG: What's next for research on this topic?

Dr Shah: The goal now is to keep our work up-to-date as reimbursement structures evolve and to ensure advocacy to get the right treatments for the right patient. And, there are similar problems in other health systems around the world that would benefit from this type of work as we adapt our datasets to meet local needs.

JG: What do you believe is the overall take-home message from our conversation today?

Dr Shah: Having conversations about cost is very important, and we shouldn't be afraid of discussing costs with our patients. Ideally, cost barriers should not translate into an inferior treatment choice. If we perceive that we have to make inferior treatment choices, then that suggests a policy issue that needs to be addressed. At the same time, it is important that patients understand the relative health outcomes and costs, to ensure that they make the choice that is right for them.

JG: Well, thank you so much, Dr. Shah. Is there anything that you'd like to add that we perhaps didn't cover?

Dr Shah: No, I think our discussion was comprehensive and these were great questions, and thank you for inviting me.

JG: Of course. Thank you again.