Economic burden associated with chronic constipation in Sweden: a retrospective cohort study

Introduction

Chronic constipation is a common gastrointestinal disorder defined by the Rome III criteria as the presence of constipation symptoms for the last 3 months with symptom onset at least 6 months before diagnosis.¹ The condition is initially managed with diet and lifestyle changes, followed by use of over-the-counter or prescription laxatives and enemas. Recently, novel drugs such as prucalopride, linaclotide, and lubiprostone have also become available.

The exact prevalence of chronic constipation has been hard to establish, with a recent systematic review finding a global prevalence ranging from 2.5% to 79% in adults, with a median of 16%.² A patient survey in the USA described a considerable duration of chronic constipation, with 21% of respondents (117 of a total of 557) reporting having had symptoms for 10 years.³ The prevalence of chronic constipation appears to increase with age;⁴ however, there is some debate in the literature about the effect of aging on constipation, and this increased prevalence may be due to increased self-reporting of constipation in elderly populations or to an increase in constipation secondary to other causes.^4,5 A predominance of constipation in women has been reported worldwide, with a median and mean female/male ratio of 1.5 and 2.1, respectively.^2,4 A population-based survey of bowel habits in Sweden found that 14% of 1,610 adults had self-reported constipation; this rose to 20% among women.⁶ In addition, 22% of elderly women and 10% of elderly men reported using laxatives in this survey.⁶

Studies in several countries, including the USA, have shown that the burden on health care resources associated with chronic constipation is substantial.^7,8 A study of a US health maintenance organization found that mean total annual health care costs (including inpatient and outpatient costs, prescription and nonprescription medication costs, and the costs of alternative therapies) were US$7,522 (95% confidence interval [CI] 5,689–9,146) for patients with constipation in 2001–2002.⁷ A second study in the USA found that the total direct health care costs for patients with constipation in the California Medicaid system were US$18,891,008 (US$246 per patient) when these costs were calculated over a 15-month period during 1995–2003.⁸

There is, however, a lack of comprehensive studies that have assessed...