Economic Impact and Prognostic Factors of Functional Dyspepsia in Children

Abstract

Objectives: Functional dyspepsia (FD) is a functional abdominal pain disorder. There is paucity of data on the economic impact of FD in children. Primary aim of our study was to estimate annual evaluation cost (“diagnosis and visit” cost) and secondary aim was to identify potential prognostic factors of FD in children. Methods: Out of the 136 patients 86 met inclusion criteria and were divided into 2 clinical groups: Complete Improvement Group (CIG-30 patients) and Partial/No Improvement Group (PIG/NIG-56 patients). Medications used were noted descriptively. Annual evaluation cost was calculated using 2017 Medicare reimbursement rates. Results: Annual evaluation cost in all patients was $724.874 ± $180.075 ($544.799 ± $87.995 in CIG and $904.949 ± 79.083 in PIG/NIG). An extrapolated annual cost of evaluation in children with FD would be approximately $5.79 billion. Average number of clinic visits (3.1 ± 1.2 in CIG vs 4.40 ± 3.1 in PIG/NIG), duration of follow-up in months (9.2 ± 6.6 in CIG vs 17.1 ± 13.6 in PIG/NIG), use of imaging studies (7 patients in CIG [23.3%] vs 29 in PIG/NIG [51.8%]) and endoscopic procedures (17 in CIG [56.7%] vs 46 in PIG/NIG [82.1%]) were significantly higher in PIG/NIG (P < 0.005). PIG/NIG required multiple medications for control of symptoms compared to CIG (4 patients in CIG [13.5%] vs 30 in PIG [53.6%], P value <0.001]. For every $500.00 decrease in total evaluation cost the odds of having a complete response was 0.998 (P = 0.027). No prognostic factors were identified in children with FD. Conclusions: FD in children has a significant economic impact on health care expenditure. Patients with FD who have partial/no response to treatment incur greater financial cost potentially adding to health care expenditure.

Evaluation of main functional dyspepsia symptoms after probiotic administration in patients receiving conventional pharmacological therapies

“…5 In the USA alone, social and economic costs are estimated to be approximately $18.4 billion/year for adults and $5.79 billion/year for children. 4,6…”

“…5 In the USA alone, social and economic costs are estimated to be approximately $18.4 billion/year for adults and $5.79 billion/year for children. 4,6 Functional dyspepsia is a chronic GI disorder defined by upper abdominal symptoms originating from the gastroduodenal region and characterized by the absence of morphological disease on routine investigations, including upper GI endoscopy. [1][2][3]7,8 The Rome IV criteria define dyspepsia as any combination of four specific symptoms: (I) postprandial filling; (II) early satiety; (III) epigastric pain; and (IV) epigastric burning.…”

Symptomatic Treatment of Pain-Related Pediatric Functional Gastrointestinal Disorders in a Biopsychosocial Construct, and a Validity Study of Rome III Criteria

“…Lane and colleagues 8 found that adding endoscopy to the analysis causes a 9-fold increase in costs. Mani and colleagues 31 found cost of evaluation to be $5.79 billion annually when treating children with functional dyspepsia. An 11-country survey in Europe found 62% of responders utilized laboratory tests and endoscopy to diagnose IBS, and 29% referred IBS patients to a specialist.…”

Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders

“…The costs of care of pediatric AP-FGIDs are significant and continue to rise [3][4][5]. These costs are particularly high in patients who are unresponsive or only partially responsive to treatment [6]. In addition, up to 30% of AP-FGIDs persist into adulthood, where the health care costs of IBS alone are over USD 20 billion per year [3,4].…”

“…Unfortunately, there are currently no evidence-based pediatric practice guidelines to direct care of these patients. There is a critical need to assess treatment in terms of value or, in other words, the outcomes relative to costs [6,7]. This could be accomplished through multi-site quality improvement projects provided there is sufficient variability in outcomes and/or costs among centers.…”