P3376 - Irritable Bowel Syndrome Therapy and Cost in Uninsured

Tuesday, October 24, 2023

10:30 AM – 4:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Tijana Samardzic, MD (she/her/hers)

Yale-Waterbury Hospital
Waterbury, CT

Tijana Samardzic, MD¹, Xiao Jing Wang, MD²
¹Yale-Waterbury Hospital, Waterbury, CT; ²Mayo Clinic, Rochester, MN

Introduction: Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal illnesses leading to high morbidity and decreased quality of life despite available therapeutic options. The cost of therapy often plays a decisive role for physicians and patients, particularly among the uninsured. We sought to determine costs for guideline-driven treatments for uninsured patients to aid in decision-making within these systems.

Methods: We selected therapies recommended in the American College of Gastroenterology’s Clinical Guideline for Management of IBS, based on recommendation and grade of evidence, to treat respective types of IBS. Using GoodRx and the Walmart $4 List, we found out-of-pocket, and savings costs of guideline-recommended medications.

Results: We found that treatment options for global symptoms of IBS have an overall lower cost with the addition of having moderate quality of evidence for their use whereas those for more specific types of IBS tend to be more expensive.

Gut-directed cognitive behavioral therapy (CBT), hypnotherapy (GDHT), relaxation therapy, among others are known efficacious additions to pharmacological and lifestyle interventions with long-term efficacy. Therapists specializing in this field are scarce, particularly in less urban settings. The ROME website, American Society of Clinical Hypnosis (ASCH), and Psychology Today list recommended providers by zip code. Attempts were made to contact all the offices listed surrounding a particular small-urban setting, simulating a patient experience, with limited success despite several voicemails. All listings included payment options with insurance. Additionally, several digital therapeutics are available for use including Mahana, Regulora, Nerva, and Zemedy. The two former listed are FDA-approved and require a prescription to join, whereas the latter two do not.

Discussion: Given the high prevalence and morbidity of IBS, finding appropriate and cost-effective treatments in all populations is imperative, particularly for uninsured individuals as many of the latest medications are high in cost, limiting use. Although gut-directed therapies are promising additions to pharmacologic treatment, the availability and expense are setbacks to access. This guide aims to be a reference for both clinicians and patients, specifically for those without insurance, to aim for transparency in pricing and offer several options in treatment based on professional recommendations.

Intervention	Out-of-Pocket Cost	Therapy Indication	Level of Recommendation	Grade of Evidence by ACG
Tegaserod*	$574.69	IBS-C	Strong/conditional recommendation	Low quality of evidence
TCA: Amitriptyline**	$12.15	All subtypes of IBS	Strong recommendation	Moderate quality of evidence
TCA: Imipramine	$35.89	All subtypes of IBS	Strong recommendation	Moderate quality of evidence
TCA: Nortriptyline **	$13.12	IBS-D	Strong recommendation	Moderate quality of evidence
Lubiprostone	$173.33	IBS-C	Strong recommendation	Moderate quality of evidence
Linaclotide	$587.73	IBS-C	Strong recommendation	High quality of evidence
Dicyclomine*	$67.81	All subtypes of IBS	Not recommended (conditionally)	Low quality of evidence
Rifaximin	$3,274.93	IBS-D	Strong recommendation	Moderate quality of evidence
Eluxadoline	$1,708.07	IBS-D	Conditional recommendation	Moderate quality of evidence
Alosetron	$1,223.33	IBS-D	Conditional recommendation	Low quality of evidence
Soluble Fiber***	$0.30 per serving	Global IBS symptoms	Strong recommendation	Moderate quality of evidence
Peppermint	$0.26 per serving	Global IBS symptoms	Conditional recommendation	Low quality of evidence
Probiotics	$0.37 per serving	Global IBS symptoms	Not recommended (conditionally)	Very low quality of evidence
PEG products	$0.91 per serving	Global IBS symptoms	Not recommended (conditionally)	Low quality of evidence
Imodium	$1.18 per serving	Global IBS symptoms	Not listed	Not listed
Digital App: Mahana	$199	CBT	Conditional recommendation	Very low quality of evidence
Digital App: Regulora	$75	GDHT	Conditional recommendation	Very low quality of evidence
Digital App: Nerva	$79.99 (in app store) or $79 (on website)	GDHT	Conditional recommendation	Very low quality of evidence
Digital App: Zemedy	$19.49/month or $154.99/year	CBT	Conditional recommendation	Very low quality of evidence

Disclosures:

Tijana Samardzic indicated no relevant financial relationships.

Xiao Jing Wang indicated no relevant financial relationships.

Tijana Samardzic, MD¹, Xiao Jing Wang, MD². P3376 - Irritable Bowel Syndrome Therapy and Cost in Uninsured, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.