The study, published in the May issue of Gastroenterology, showed the most prevalent diseases were non-food-borne gastroenteritis with 135 million cases a year, food-borne illnesses with 76 million cases, gastroesophageal reflux disease with 19 million cases and irritable bowel syndrome with 15 million cases.
Commissioned by the American Gastroenterological Association of Bethesda, Md., the study chiefly relied on data assembled by the Lewin Group, a Falls Church, Va.-based research organization.
“The disease with the highest annual direct costs in the U.S. was gastroesophageal reflux disease, or GERD, at $9.3 billion,” said Dr. Robert S. Sandler, professor of medicine and epidemiology. “Gallbladder disease cost $5.8 billion, colorectal cancer $4.8 billion and peptic ulcer disease $3.1 billion.”
Estimated direct costs of the 17 gastrointestinal and liver diseases the researchers examined specifically were $36 billion in 1998 dollars, with estimated indirect costs of $22.8 billion, Sandler said.
“Our conclusion is that GI and liver diseases exact heavy economic and social costs in the United States,” he said. “Understanding the prevalence and costs of these diseases is important to help set priorities to reduce the nation’s burden of illness.”
Sandler, co-director of UNC’s Center for Gastrointestinal Biology and Disease, said the study was spurred by the fact that the cost of digestive diseases nationally was not known. Good data have not been available and pooled to answer that question, he said.
“We felt that if we could assemble this information, it would be useful to policy-makers, planners, health plans and other organizations,” the physician said. “What the Lewin group did was to pull together data on the costs of hospitalizations, physicians and drugs for these illnesses, which are straight forward. It is a lot harder to add up indirect costs for such things as such as missed work, time people can’t spend doing their other daily activities, pain and suffering and premature death. For that reason, our estimates of the indirect costs are even more conservative than the estimates of the direct costs.”
The new information could help Congress, for example, determine how to allocate research grant and contract money, Sandler said. In 2000, total National Institutes of Health research expenditures for digestive diseases was $676 million.
Previous research has suggested that some illnesses such as AIDS, breast cancer and dementia received significantly more research dollars than comparably debilitating and costly but less well-publicized conditions, he said.
Co-authors of the report include Drs. James E. Everhart of the National Institute of Diabetes and Digestive and Kidney Diseases, Mark Donowitz of Johns Hopkins University, Elizabeth Adams of the American Gastroenterological Association (AGA), and Eric Gemmen, Clifford Goodman and other staff members of the Lewin Group.
The study could not take into account costs associated with long-term care such as nursing homes and home care associated with liver and GI illnesses, Sandler said. Nor could the researchers factor in expenses from federal facilities such as military and veterans’ hospitals and the Indian Health Service, which generate about 10 percent of U.S. health-care costs.
“People who suffer from these diseases but do not have the health insurance coverage or other resources at their disposal to access health care services are underdiagnosed and undertreated,” he said. “Because some of these diseases are inversely correlated with socioeconomic status, there is likely to be underreporting.”
Note: Sandler can be reached at (919) 966-0090 or via e-mail at rsandler@med.unc.edu. Copies of the paper are available to reporters who call Kay Twomey at the AGA press office at (301) 654-2055. Contact: David Williamson, (919) 962-8596.
By DAVID WILLIAMSON
UNC News Services
Journal
GASTROENTEROLOGY