The following is a summary of “Optimizing the Management Algorithm for Adults With Functional Constipation Failing a Fiber/Laxative Trial in General Gastroenterology: Cost-Effectiveness and Cost-Minimization Analysis,” published in the February 2024 issue of Gastroenterology by Shah, et al.

Anorectal function testing, typically conducted in specialized centers, is an office-based procedure that holds the potential for guiding care in patients with Rome IV functional constipation who have not responded to over-the-counter therapy. This approach could serve as an alternative to empirically prescribing drugs. For a study, researchers sought to assess the cost-effectiveness of routine anorectal function testing in this specific patient population.

They conducted a cost-effectiveness analysis from the patient perspective and a cost-minimization analysis from the insurer perspective to compare three strategies: empiric prescription drugs followed by pelvic floor physical therapy (PFPT) for drug failure, empiric PFPT followed by prescription drugs for PFPT failure, or care guided by upfront anorectal function testing. Model inputs were sourced from systematic reviews of prospective clinical trials, national cost data sets, and observational cohort studies assessing the impact of chronic constipation on health outcomes, healthcare costs, and work productivity.

The most cost-effective strategy was upfront anorectal function testing to guide patients to appropriate therapy. Specifically, patients without anal hypocontractility on anorectal manometry and with a balloon expulsion time of at least 6.5 seconds would be referred to PFPT. Sensitivity analysis indicated that empiric PFPT was generally more cost-effective than empiric prescription drugs, except when the primary treatment goal was to increase bowel movement frequency. Adoption of this strategy would lead gastroenterologists to refer approximately 17 patients annually to PFPT, indicating feasibility.

Anorectal function testing emerged as a technology to optimize cost-effective outcomes by tailoring care based on patient phenotypes, potentially offsetting testing costs.

Reference: journals.lww.com/ajg/abstract/2024/02000/optimizing_the_management_algorithm_for_adults.24.aspx