Am J Gastroenterol 2021 Apr;116(4):748-757
1Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USA; 2Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; 3Department of Psychiatry, Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USA; 4Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Australia; 5Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; 6Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA.
Introduction: Insurance coverage is an important determinant of treatment choice in irritable bowel syndrome (IBS), often taking precedence over desired mechanisms of action or patient goals/values. We aimed to determine whether routine and algorithmic coverage restrictions are cost-effective from a commercial insurer perspective.
Methods: A multilevel microsimulation tracking costs and outcomes among 10 million hypothetical moderate-to-severe patients with IBS was developed to model all possible algorithms including common global IBS treatments (neuromodulators; low fermentable oligo-, di-, and mono-saccharides, and polyols; and cognitive behavioral therapy) and prescription drugs treating diarrhea-predominant IBS (IBS-D) or constipation-predominant IBS (IBS-C) over 1 year. Read More