Healthcare utilisation and healthcare costs for patients with hypermobile spectrum disorders and coexisting functional dyspepsia and/or irritable bowel syndrome
Upadhyaya A., Topan R., Pandya S., Williams S., Fragkos K., Zarate-Lopez N., Roukas C., Mihaylova B., Fikree A.
Background/objective Disorders of Gut–Brain interactions (DGBI), for example, Functional Dyspepsia (FD) or Irritable Bowel syndrome (IBS), are common in patients with hypermobile EhlersDanlos syndrome/hypermobile spectrum disorder (hEDS/HSD). DGBI is associated with significant healthcare use—how this applies to patients with coexisting hEDS/HSD is unknown. Design A cross-sectional study was performed. Patients recruited from tertiary neurogastroenterology clinics and from EhlersDanlos Support UK completed questionnaires, characterising their demographic, healthcare data and expenses, over 6 months (July 2021–January 2022) and their Rome IV diagnoses. National Health Service (NHS) unit costs were used. Healthcare use and costs were compared across and between DGBI and non-DGBI subgroups. Regression analysis was performed to determine predictors of costs. p<0.005 was considered significant. Results Median age of the 660 respondents was 39 (IQR: 29–50) years; 96.1% had a DGBI. 13.6% had IBS, 29.9% had FD, 32.1% had IBS and FD, 24.4% had neither. Patients with DGBI had high healthcare use and large healthcare costs; £3388.79/6 months, mostly attributed to consultations (36.4%) and admissions (22.7%). Costs per patient (pp) were at least double in any group with FD (£4026.53– £4297.30pp) compared with those without (£1372.49–£1979.36pp), p<0.001. The highest costs were in FD patients (>£20 000 pp/6months). Predictors of rising costs were FD, non-gastrointestinal comorbidities, lower body mass index, positive avoidant/restrictive food intake disorders screen, having an altered diet, polypharmacy, visits to different healthcare professionals and tertiary neurogastroenterology recruitment. Conclusions It is imperative to develop cost-effective multidisciplinary services for hEDS/HSD patients with FD, particularly in the current fiscal climate, as they have significant healthcare use and costs.