America's Tummyaches Cost Billions

Docs hope research will lead to new treatments

TUESDAY, April 30, 2002 (HealthDayNews) -- From heartburn to food poisoning to more serious gastrointestinal diseases, Americans' bellyaches cost an estimated $85.5 billion a year.

New research that appears in the May issue of Gastroenterology calculated the price tag for the most significant gastrointestinal ailments and liver diseases that commonly afflict Americans, and found the toll on the nation from such conditions is heavy.

The most prevalent digestive diseases include: non-food-borne gastroenteritis, 135 million cases per year; food-borne illnesses, 76 million cases; gastro-esophageal reflux disease (GERD), 19 million cases; and irritable bowel syndrome (IBS), 15 million cases.

A high ranking in prevalence, however, doesn't necessarily translate to the highest cost -- the most expensive disease was GERD, a chronic acid reflux condition, which has an estimated $9.3 billion price tag per year. That's followed by gallbladder disease, at $5.8 billion; colorectal cancer, at $4.8 billion; and peptic ulcer disease, at $3.1 billion.

The research, commissioned by the American Gastroenterological Association, used data assembled by the Falls Church, Va.-based Lewin Group and reflects information from 1998.

The costs attributed to conditions represent a combination of two factors -- direct costs, including drugs, doctors and hospitalizations, and indirect costs, which range from missed work and activities missed because of pain and suffering to premature death.

While some conditions lean heavily on direct costs, others may have exceptionally high indirect costs, explains lead researcher Dr. Robert Sandler, a professor of medicine and epidemiology at the University of North Carolina.

"GERD, for instance, ranked the highest in cost, not because of indirect costs -- most people with the condition can indeed go to work. The expenses fall mostly on the direct costs side because the drugs to treat the condition are terribly expensive," he explains.

On the other hand, costs for another highly prevalent condition, IBS, which causes chronic bowel problems and abdominal pain, are attributed almost entirely to indirect costs.

"IBS is a very expensive condition in terms of indirect costs, but not for direct costs because there are no effective therapies that are approved by the {Food and Drug Administration], so there's a real disconnect there," Sandler explains.

Altogether, the 17 most prominent gastrointestinal and liver diseases were estimated to cost $36 billion in direct costs and about $22.8 billion in indirect costs.

Ideally, the payoff of direct costs, such as better treatments, would be a reduction of indirect costs. Finding better treatments for food-borne illnesses, for example, would erase those lost days of work from food-related intestinal ailments, explains Dr. Mark Donowitz, the LeBoff professor of medicine at Johns Hopkins University who is co-author of the study.

"If we could find some kind of magic antibiotic or something that could stop the diarrhea in those cases, we could really reduce time lost from work," he says.

Inflammatory bowel disease (IBD), which also causes diarrhea, bleeding and other symptoms, is another example of a condition whose cost could decrease with more attention, he says.

"IBD is a condition in which patients that are heavy in their use of physicians' time and hospital care because we don't quite understand how the disease works and we don't have very good ways of dealing with it yet."

"Once we do, though, we're very hopeful we'll be able to decrease the costs both for the treatment and for time lost for the patients," Donowitz says.

As recently as 2000, the National Institutes of Health spent $676 million on research for digestive diseases, and Sandler says he hopes the information in the new study can help officials decide where such funds should go.

"Gall bladder disease, for instance, is tremendously expensive. It's very common, and the treatment is expensive because it involves surgery," he says.

"But there apparently isn't a whole lot of research on gall bladder disease, and we need to know more about why people get gallstones, how to prevent them…," Sandler says.

Sandler adds that he hopes the research will increase awareness of just how common -- and expensive -- conditions are that have long been swept under the rug because many people simply don't want to talk about them.

"There was a slogan for a colon cancer campaign a few years back that went something like 'Don't Die from Embarrassment,' and that really captures the general problem with gastrointestinal conditions," Sandler says.

"Lobbying efforts for many of these diseases are hindered because they are frankly embarrassing to people," he adds. "You've got, for instance, breast cancer and AIDS lobbyists that have been very effective in getting research funds, but you don't see many diarrhea lobbying groups out there because people are simply embarrassed about diarrhea."

What To Do

Visit the American College of Gastroenterology for more information on Common GI Problems.

And check out the American Gastroenterological Association's site on Digestive Health and Nutrition.

SOURCES: Robert Sandler, M.D., professor, medicine and epidemiology, University of North Carolina, Chapel Hill; Mark Donowitz, M.D., LeBoff Professor of Medicine, and director, Hopkins Center for Epithelial Disorders, Johns Hopkins University, Baltimore; May 2002 Gastroenterology
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