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HEALTHCARE UTILISATION AND COSTS FOR HYPERMOBILE EHLERS-DANLOS SYNDROME PATIENTS WITH CONCOMITANT FUNCTIONAL DYSPEPSIA AND IRRITABLE BOWEL SYNDROME

Advait Upadhyaya 1, Rabia Topan 1, Shraya Pandya 1, Sarah Williams 2, Natalia Zarate-Lopez 3, Qasim Aziz 4, Chris Roukas 5, Borislava Mihaylova 5, Asma Fikree 6

Affiliations

1 Barts and the London School of Medicine and Dentistry, Wingate Institute, London, United Kingdom

2 Royal London Hospital, London, United Kingdom

3 University College London Hospitals NHS Foundation Trust, London, United Kingdom

4 Wingate Institute for Neurogastroenterology - Centre for Neuroscience and Trauma, London, United Kingdom

5 Queen Mary University of London, London, United Kingdom

6 Barts Health NHS Trust, London, United Kingdom

Summary

AI Generated

In a cross-sectional study of 660 patients with hypermobile Ehlers-Danlos syndrome/hypermobile spectrum disorder, those with functional dyspepsia had significantly higher healthcare costs and utilization than those with irritable bowel syndrome only or neither condition.

Total healthcare costs per patient over 6 months were £3782.82 for functional dyspepsia only and £3622.15 for both functional dyspepsia and irritable bowel syndrome, compared to £1610.12 for irritable bowel syndrome only and £1376.34 for neither condition (p<0.001).
Patients with functional dyspepsia had significantly more outpatient visits (median 9 versus 4-7.5), hospital admissions (16.8% versus 2.2-5%), and use of clinically assisted nutrition and hydration (37.6% versus 8.9-9.9%).
Consultations and admissions contributed 31.3% and 27.4% of total costs respectively, with the 10 highest individual costs (£21,653.80-£99,983.90) all occurring in patients with functional dyspepsia who required inpatient admission.
Quality of life scores were significantly lower in patients with functional dyspepsia (0.253) compared to irritable bowel syndrome only (0.511) or neither condition (0.519), with 22.0% of the entire cohort scoring below zero.
Polypharmacy and employment status were the strongest independent predictors of rising healthcare costs in the multivariate regression analysis.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Disorders of Gut-Brain Interactions (DGBIs), such as functional dyspepsia (FD) or Irritable Bowel Syndrome (IBS) are common in patients with Hypermobile Ehlers-Danlos Syndrome/Hypermobile Spectrum Disorder (hEDS/HSD)¹. Healthcare utilisation (HCU) is high in DGBIs but no study to date has looked at HCU or healthcare costs (HCC) in patients with hEDS/HSD and these DGBIs.

Aims & Methods

To calculate the healthcare costs associated with patients with hEDS/HSD and FD and/or IBS.
A cross-sectional study was performed. Patients completed a ROME IV, SF6 (quality of life questionnaire) and HCU questionnaire. The latter was adapted from the IBD Boost study² and included consultations, admissions, clinically assisted nutrition and hydration (CANH), medications and personal expenses over 6 months. Costs were calculated based on the National Schedule of NHS Costs³ and NHS Business Services Authority Prescription Cost Analysis⁴. Patients were grouped based on ROME IV diagnoses of FD and IBS. Chi-squared was used for categorical data. The Kruskal-Wallis test was used for continuous variables. A multivariate regression analysis was performed to see what healthcare characteristics were the strongest predictors of rising HCCs. In view of the multiple comparisons p<0.005 was considered significant.

Results

660 hEDS/HSD patients completed the study; 92.9% were female, median age 39 years. 90(13.2%) had IBS only, 197(29.0%) had FD only, 212(31.2%) had both FD and IBS and 161(23.7%) had neither IBS nor FD. Table 1 describes and compares HCU across the 4 groups. There were significantly more outpatient visits, admissions and CANH use in patients with FD±IBS. Total HCC per patient was significantly higher in patients with both FD and IBS (£3622.15) and FD only (£3782.82) compared to IBS only (£1610.12,p<0.001) and neither IBS nor FD (£1376.34,p<0.001). Consultations and admissions contributed to the majority of total HCC (31.3% and 27.4% respectively). Rheumatology and Gastroenterology were the commonest secondary/tertiary services used. CANH was used in 37.6% of patients with FD only and 29.2% of patients with both FD and IBS and accounted for 11% and 7% of total HCC in these DGBI groups respectively. The 10 highest HCCs (£21,653.80-£99,983.90) were in patients with FD±IBS, and they all required an inpatient admission.
The average SF6 in patients with FD±IBS (0.253) was significantly lower than in patients with IBS only (0.511,p<0.001) or those with neither IBS nor FD (0.519,p<0.001). 22.0% of the entire cohort had a score less than 0, which is a quality of life worse than death.
The adjusted R² value of the regression model used to determine what factors independently correlated with rising HCCs was 0.527. The variables significantly predicted rising HCCs, F(31,557)=3.775, p<0.001. 'Polypharmacy' and 'Employment Status' were the greatest predictors of rising healthcare costs (β=-0.209, p<0.001 and β=-0.121,p=0.003 respectively).

Table 1: Comparison of HCU in hEDS/HSD with and without FD and IBS over 6 months.

	Neither IBS nor FD (n=161)	IBS only (n=90)	FD only (n=197)	Both FD and IBS (n=212)	p-value (comparing differences across all groups)
Median number of outpatients visits per patient(range)	4(0-104)	7.5(0-84)	9(0-135)	9(0-102)	<0.001
Number(%) with ≥1 admission	8(5)	2(2.2)	33(16.8)	26(12.3)	<0.001
The median number of investigations per patient(range)	2(0-12)	3(0-8)	2(0-10)	2.5(0-11)	0.742
Number(%) on CANH	16(9.9)	8(8.9)	74(37.6)	62(29.2)	<0.001
The median number of medications per patient(range)	6(0-18)	7(1-17)	6(1-17)	7(1-23)	0.132

Conclusion

In hEDS/HSD patients, those with FD±IBS had the highest HCU and HCC highlighting the need to prioritise the development of cost-effective services for those with foregut disorders.

References

¹Lam et al. Clinical Gastroenterology and Hepatology 2021;19(2)
²Roukas et al. Frontline Gastroenterology 2022;14(1)
³England N. 2019/20 National Cost Collection Data Publication 2022
⁴NHSBSA. Prescription Cost Analysis – England 2020/21 2021

Conference

UEG Week Copenhagen 2023

Submission format

Abstract

Session

PP 10 Health economics / Digitalisation in GI / Education In GI / Gender and diversity (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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FUNCTIONAL NAUSEA AND DISORDERED EATING IMPACT NUTRIENT INTAKE IN PATIENTS WITH HYPERMOBILE EHLERS DANLOS SYNDROME (HEDS) - A LARGE CROSS SECTIONAL STUDY

Rabia Topan 1, Paula Chance 2, Shraya Pandya 3, Qasim Aziz 4, Natalia Zarate-Lopez 5, Janet Kyle 6, Asma Fikree 5, Kevin Whelan 7

Affiliations

1 Wingate Institute of Neurogastroenterology, Sutton, United Kingdom

2 Kings College University, London, United Kingdom

3 Queen Marys University London, London, United Kingdom

4 Wingate Institute for Neurogastroenterology - Centre for Neuroscience and Trauma, London, United Kingdom

5 University College London Hospital, London, United Kingdom

6 University Of Aberdeen, Aberdeen, United Kingdom

7 King's College London - Diabetes & Nutritional Sciences Division, London, United Kingdom