Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10450-10460
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10450
Economic burden of irritable bowel syndrome in China
Fang Zhang, Wei Xiang, Chun-Yan Li, Shu-Chuen Li
Fang Zhang, Wei Xiang, College of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
Chun-Yan Li, Department of Gastroenterology, First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, Liaoning Province, China
Shu-Chuen Li, Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
Author contributions: Li SC designed the study; Zhang F, Xiang W and Li CY performed the research; Xiang W analyzed the data; Zhang F and Xiang W wrote the paper; and Li SC revised the manuscript for final submission.
Institutional review board statement: Approval was taken from Institutional Review Board, The First Affiliated Hospital of Dalian Medical University Medical Ethics Committee, No. LCKY2014-31.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Shu-Chuen Li, PhD, Professor, Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia.
Telephone: +61-2-49215921 Fax: +61-2-49215921
Received: July 28, 2016
Peer-review started: August 2, 2016
First decision: October 10, 2016
Revised: November 1, 2016
Accepted: November 28, 2016
Article in press: November 28, 2016
Published online: December 21, 2016

To estimate annual direct and indirect costs for patients diagnosed with irritable bowel syndrome (IBS) and subtypes.


Patients completed a standardized questionnaire concerning usage of healthcare resources, travel costs, meals, and productivity loss of patients when seeking treatment for IBS. Total annual costs per patient were calculated as the sum of direct (including medical and nonmedical) and indirect costs. Total annual costs per patient among various IBS subtypes were compared. Analysis of variance and bootstrapped independent sample t-tests were performed to determine differences between groups after controlling for IBS subtypes.


A total of 105 IBS patients (64.80% female), mean age of 57.12 years ± 10.31 years), mean disease duration of 4.31 years ± 5.40 years, were included. Total annual costs per patient were estimated as CNY18262.84 (USD2933.08). Inpatient and outpatient healthcare use were major cost drivers, accounting for 46.41%and 23.36% of total annual costs, respectively. Productivity loss accounted for 25.32% of total annual costs. The proportions of direct and indirect costs were similar to published studies in other countries. Nationally, the total costs of managing IBS would amount to CNY123.83 billion (USD1.99 billion). Among the IBS subtypes, total annual costs per patient of IBS-M was highest at CNY18891.18 (USD3034). Furthermore, there was significant difference in productivity loss among IBS subtypes (P = 0.031).


IBS imposes a huge economic burden on patients and healthcare systems, which could account for 3.3% of the total healthcare budget for the entire Chinese nation. More than two-thirds of total annual costs of IBS consist of inpatient and outpatient healthcare use. Among the subtypes, IBS-M patients appear to have the greatest economic burden but require further confirmation.

Keywords: Irritable bowel syndrome, Burden of illness, Direct and indirect medical and nonmedical costs, Irritable bowel syndrome subtype, Productivity loss

Core tip: This study was the first article to evaluate the costs of patients with irritable bowel syndrome (IBS) in China, including all costs associated with care of patients with IBS, and allowed a more reliable estimation of true costs. In addition, unlike other published studies, this study also analyzed the costs of patients with four IBS subtypes, finding a difference in indirect costs among IBS subtypes. This would provide a benchmark for other researchers engaged in studying IBS.