Economic burden of irritable bowel syndrome in China

Table 1 Characteristics of four irritable bowel syndrome-subtypes n (%)

Characteristics	IBS (n = 105)	IBS-C (n = 23)	IBS-D (n = 42)	IBS-M (n =9)	IBS-U (n = 31)	P value
Age (yr) (mean ± SD)	57.1 ± 10.3	60.3 ± 8.7	54.9 ± 11.9	52.0 ± 9.6	59.3 ± 8.2	0.0491
≤ 50	24 (22.9)	2 (8.7)	12 (28.6)	5 (55.6)	5 (16.1)
51-60	39 (37.1)	11 (47.8)	14 (33.3)	1 (11.1)	13 (41.9)
61-70	35 (33.3)	8 (34.8)	13 (31.0)	3 (33.3)	11 (35.5)
≥ 71	7 (6.7)	2 (8.7)	3 (7.1)	0 (0.0)	2 (6.5)
Disease duration (yr) (mean ± SD)	4.3 ± 5.4	3.0 ± 2.7	5.0 ± 5.7	6.8 ± 10.6	3.8 ± 4.3	0.247
< 1	33 (31.4)	8 (34.8)	11 (26.2)	3 (33.3)	11 (35.5)
1-3	33 (31.4)	9 (39.2)	13 (31.0)	4 (44.4)	9 (29.0)
3-5	19 (18.2)	3 (13.0)	8 (19.0)	0 (0.0)	6 (19.4)
> 5	20 (19.0)	3 (13.0)	10 (23.8)	2 (22.3)	5 (16.1)
Gender						< 0.0012
Male	37 (35.2)	6 (26.1)	24 (57.1)	4 (44.4)	3 (9.7)
Female	68 (64.8)	17 (73.9)	18 (42.8)	5 (55.6)	28 (90.3)
Employment Status						0.094
Retired	42 (40.0)	10 (43.5)	16 (38.1)	3 (33.3)	13 (41.9)
Employed	63 (60.0)	13 (56.5)	26 (61.9)	6 (66.7)	8 (58.1)
Income level						0.096
Lower income	43 (40.9)	10 (43.5)	15 (35.7)	5 (55.6)	13 (41.9)
Middle income	55 (52.4)	12 (52.2)	25 (59.5)	2 (22.2)	16 (51.6)
Higher income	7 (6.7)	1 (4.3)	2 (4.8)	2 (22.2)	2 (6.5)

¹There was significant difference between age distribution of irritable bowel syndrome-constipation (IBS-C) vs IBS-diarrhea (IBS-D) vs IBS-mixed (IBS-M) vs IBS-unclassified (IBS-U) (P = 0.049);

²There was significant difference between gender distribution of IBS-C vs IBS-D vs IBS-M vs IBS-U (P < 0.001). Lower income: < 5000 yuan/mo; Middle income: 5000-10000 yuan/mo; Higher income: > 10000 yuan/mo.

Table 2 Direct medical costs (CNY yuan)

Direct medical costs	No. of patients	Average visits per 4 wk	Average visits per year	4-wk drug cost per patient	4-wk medical cost per patient	Annual costs per patient
Outpatient	99 (94.29%)	1.01	12.42	213.57 (185.86-246.95)	112.49 (82.04-142.77)	4266.58 (3705.55-4838.44)
Pharmacy	13 (12.38%)	1.08	1.72	17.33 (7.53-28.29)	0.76 (0.34-1.25)	31.56 (13.74- 51.29)
Inpatient	105 (100%)	0.01	1.28	290.76 (261.82-320.29)	359.03 (340.65-377.07)	8476.30 (7888.07-9050.18)
Total costs				521.67 (76.32-91.09)	472.28 (437.26-507.22)	12761.14 (11885.82-13595.74)

Table 3 Direct nonmedical costs (CNY yuan)

Direct nonmedical costs	No. of patients	4-wk costs per patient	Annual costs per patient
Travel	105 (100%)	23.06 (19.65-26.57)	749.75 (645.57-867.93)
Meals	98 (93.33%)	6.49 (4.77-8.30)	79.03 (58.16-101.00)
Health food	8 (7.62%)	49.05 (14.28-97.13)	48.75 (14.20-96.55)
Total costs		78.60 (42.55-127.91)	877.54 (752.62-1022.94)

Table 4 Indirect costs (CNY yuan)

Indirect costs	4-wk lost work days	Average costs per 4 wk	Annual lost work days per patient	Annual costs per patient
Outpatient	0.62 (0.57-0.68)	108.71 (99.60-117.84)	8.14 (7.45-8.88)	1337.07 (1225.06-1449.34)
Pharmacy	0.06 (0.03-0.10)	10.79 (4.98-17.43)	0.81 (0.37-1.30)	17.42 (8.04-28.15)
Inpatient	1.10 (1.04-1.16)	190.85 (180.80-202.17)	14.29 (13.54-15.13)	2489.59 (2358.47-1637.26)
Resting at home	0.34 (0.32-0.36)	59.80 (56.87-62.98)	4.48 (4.25-4.71)	780.07 (741.90-821.56)
Total costs	2.13 (2.04-2.22)	370.15 (355.61-386.23)	27.71 (26.62-28.91)	4624.15 (4456.32-4802.13)

Table 5 Total costs (CNY yuan)

	4-wk costs per patient	Annual costs per patient
Direct medical costs	993.95 (934.37-1059.57)	12761.14 (11885.82-13595.74)
Outpatient	326.06 (285.86-372.84)	4266.58 (3705.55-4838.44)
Pharmacy	18.10 (7.77-28.25)	31.56 (13.74- 51.29)
Inpatient	649.79 (601.91-693.69)	8476.30 (7888.07-9050.18)
Direct nonmedical costs	78.60 (42.55-127.91)	877.54 (752.62-1022.94)
Travel	23.06 (19.65-26.57)	749.75 (645.57-867.93)
Meals	6.49 (4.77-8.30)	79.03 (58.16-101.00)
Health food	49.05 (14.28-97.13)	48.75 (14.20-96.55)
Indirect costs	370.15 (355.61-386.23)	4624.15 (4456.32-4802.13)
Outpatient	108.71 (99.60-117.84)	1337.07 (1225.06-1449.34)
Pharmacy	10.79 (4.98-17.43)	17.42 (8.04-28.15)
Inpatient	190.85 (180.80-202.17)	2489.59 (2358.47-1637.26)
Resting at home	59.80 (56.87-62.98)	780.07 (741.90-821.56)
Total costs	1442.70 (1356.99-1520.09)	18262.84 (17326.86-19158.27)

Table 6 Total costs for the entire Chinese population

Total costs		National health budget	Costs as % of national health budget	GDP		Total costs as % of GDP		Units
National	Per capita			National	Per capita	National	Per capita
123.83 B (1.99 B)	18262.84 (2933.08)	3758.48 B (603.63 B)	3.29%	67670.8 B (10868.2 B)	51560.3 (8280.8)	0.18%	35%	2015CNY (2015USD)

B: Billion; GDP: Gross domestic product.

Table 7 Total costs of four irritable bowel syndrome subtypes (CNY yuan)

	IBS-C	IBS-D	IBS-M	IBS-U	P value
Direct medical costs	12036.72 (10319.41-13841.58)	12838.55 (11570.90-14221.77)	12990.03 (11094.74-14757.98)	13127.30 (11484.21-14680.82)	0.830
Direct nonmedical costs	973.31 (741.98-1252.00)	812.15 (586.09-1114.49)	986.80 (95.42-201.77)	863.34 (716.92-1025.52)	0.792
Indirect costs	4449.10 (4020.92-4893.99)	4890.66 (4648.80-5169.87)	4914.35 (4446.81-5340.35)	4308.71 (4017.27-4584.88)	0.0311
Total costs	17459.12 (15369.32-19486.61)	18541.36 (17241.44-19933.29)	18891.18 (16960.86-20813.44)	18299.35 (16423.33-20269.52)	0.817

¹There was significant difference between indirect costs of irritable bowel syndrome-constipation (IBS-C) vs IBS-diarrhea (IBS-D) vs IBS-mixed (IBS-M) vs IBS-unclassified (IBS-U) (P = 0.031).

Table 8 Economic burden per person with irritable bowel syndrome in other studies

Ref.	Country	Total costs		Units
		Direct	Indirect
This study	China	13638.68 (2190.42)1	4624.15 (801.64)1	2015CNY (2015USD)
Dean et al[52]	United States		7737 (10398)2	2005USD (2015USD)
Leong et al[23]	United States	3736 (6175)2	791 (1307)2	1998USD (2015USD)
Ricci et al[53]	United States	7547 (11758)2		2000USD (2015USD)
Ahn et al[54]	United States	1562 (2294)2		2002USD (2015USD)
Creed et al[55]	United Kingdom	1743 (2634)3	334.50 (505.45)3	2003USD (2015USD)

¹USD1 = CNY6.2265;

²The discount rate was 3% in United States;

³The discount rate was 3.5% in United Kingdom.