What is the current burden of Irritable Bowel Syndrome in primary care and cost effectiveness of referral to secondary care?

Lead Research Organisation: University of Nottingham
Department Name: School of Medicine


Irritable bowel syndrome (IBS) involves altered bowel habit, pain and bloating that causes distress and reduces quality of life. It affects up to 20% of the population at any time, with approximately 25% seeking medical advice. Despite this condition affecting large numbers of people with significant impact on their lives, relatively little is known about characteristics of individuals and their prognosis. Even less is understood about financial cost to the health service of managing IBS and the role and impact to both the individual and the health service of referral to a consultant.

This study will assess characteristics and prognosis for individuals with IBS. A model will be developed to analyse the economic impact of IBS and assess impact and cost effectiveness of referral to a consultant. Financial costs of investigations, treatment, hospital admissions and clinician time will be investigated using a database of records from UK general practices, whilst patient questionnaires will quantify loss of work productivity and quality of life and how referral to hospital alters this.

Developing an accurate economic model of IBS will allow cost effectiveness of many interventions to be assessed, providing a mechanism to reduce wasteful practice and allow more efficient use of resources.

Technical Summary

Irritable bowel syndrome (IBS) symptoms are present in 10-20% of the population and associated National Health Service expenditure may be as great as #100 million per year. Despite this, current and detailed data from large numbers of patients for occurrence, consequence, mortality and costs related to IBS in the UK is lacking

To determine the burden and consequence of a diagnosis of IBS in primary care and the cost-effectiveness of referral to secondary care
1. What is the contemporary epidemiology of IBS in UK primary care?
2. What is the epidemiology and change in health care utilization associated with secondary care referral?
3. What is the impact of secondary care referral on health related quality of life (QoL) in IBS?
4. What is the economic burden of IBS in the UK and what is the cost benefit of secondary care referral?

1. A cohort will be constructed using the General Practice Research Database (GPRD) to analyse incidence and prevalence of IBS, frequency of secondary care referrals and co-morbid conditions, prescription patterns and mortality rates
2. Using the GPRD derived cohort a self controlled case series analysis will assess any change in the number of GP consultations, prescriptions, hospital admissions, investigations and sick notes before and after referral to secondary care
3. A self-controlled questionnaire based case study of new referrals recruited from gastroenterology clinics will assess changes in QoL associated with the consultation.
4. A cost-effectiveness model will be constructed using results from the above studies based on a hypothetical cohort of IBS patients compared to the general population
Scientific and medical opportunities
This fellowship offers excellent training in clinical epidemiology and health economics using database and clinical research methods with medically important outcomes.
The large numbers of patient data will allow better understanding of current epidemiology to inform patients, clinicians and researchers.

There is currently no standardised referral pathway for patients with IBS. Assessing the impact of referral from the patient perspective and changes in health care utilisation will provide evidence to standardise practice and inform policy.

An accurate and contemporary analysis of cost burden of IBS will allow optimal use of resources and this model can be used to assess other economic questions within IBS.
Routinely available data reflects actual clinical practice and this study will continue to develop the methodology required to use it to create future health economic models in many disease areas.
Description Institute for Technology Assessment 
Organisation Massachusetts General Hospital
Department Institute for Technology Assessment
Country United States 
Sector Hospitals 
PI Contribution Generating research question, literature search and review, development of economic model, evaluation and write up.
Collaborator Contribution Training and supervision.
Impact Paper submitted for publication Two abstracts submitted to international conferences
Start Year 2012
Description Programs for the Assessment of Technologies for Health (PATH) 
Organisation Programs for Assessment of Technology in Health (PATH) Research Institute
Country Canada 
Sector Public 
PI Contribution I as part of this group for four months, developing the economic model that forms the final part of my research project. I developed and ran the model and analysed the results.
Collaborator Contribution I was mentored by Dr Daria O'Reilley and supervised by Prof Paul Moayyedi (McMaster University). I attended a two month course on advanced health economic modelling, one of the MSc modules run by McMaster University. These skills enabled me to complete the modelling required for the final part of my funded work.
Impact The outcomes of this model have been drafted into a manuscript that will hopefully be published later this year.
Start Year 2015