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 Based on claims data for employer-insured adults, the study team
estimates 1.4 million people seek outpatient care and prescription
medication for hemorrhoids each year. That doesn't include spending
on over-the-counter medications or in-hospital treatments and
surgeries.
"Hemorrhoids don't get very much attention. They are common and lead
to some large medical expenditures," said senior study author Dr.
Robert Sandler of the Center for Gastrointestinal Biology and
Disease at the University of North Carolina in Chapel Hill.
"There are office treatments available for hemorrhoids that are
quick and easy and are well-compensated," he told Reuters Health by
email. "That, of course, raises questions of potential overuse."
Sandler and colleagues looked at insurance claims in 2014 in a
database that covered nearly 19 million patients, ages 18 to 64,
with employer-provided prescription coverage. The researchers
identified patients whose primary reason for a medical visit was
hemorrhoids and who received outpatient treatments, such as rubber
band ligation or sclerotherapy, or prescription medications such as
hydrocortisone.
As reported in the American Journal of Gastroenterology, the
researchers found 227,000 patients with at least one outpatient
hemorrhoid-related claim. Among those, 119,000 had prescription
medication claims, 136,000 visited a doctor and 28,000 went to an
outpatient facility. In addition, about 33,000 underwent anoscopy or
colonoscopy.
From these figures, the researchers calculated estimates for the
overall U.S. population in this age group and with employer
insurance. They determined that about 1.4 million non-senior adults
sought care for hemorrhoids in 2014 at a total annual cost of $770
million. This includes $322 million in physician claims, $361
million in outpatient facility claims and $88 million in
prescription medication.
When they included patients with hemorrhoids as a secondary reason
for the medical visit, the totals rose to 2.5 million patients
seeking care for hemorrhoids, potentially accruing $2.4 billion in
expenses.
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These estimates don't include over-the-counter treatments for
hemorrhoids. The authors note that those expenditures are likely
considerable, too, given that worldwide sales of just one brand,
Preparation H, hit $136 million in 2017.
Some prescribed treatments - such as fiber, and a class of drugs and
natural products known as phlebotonics - have been shown to improve
hemorrhoid symptoms in the short term. But, the study team notes,
there has been no trial comparing the effectiveness of all the
nonsurgical treatments. And no study of hemorrhoids has been funded
by the National Institutes of Health in 24 years.
A limitation of the analysis, the authors acknowledge, is that it
focuses on the U.S. population with employer-provided health
insurance, which typically is younger and healthier. Hemorrhoids are
likely more common in older and disabled patients covered by
Medicare, as well as uninsured patients, they write.
Going forward, the researchers want to examine hemorrhoid risk
factors and symptoms and educate doctors and patients. For instance,
patients often make the mistake of assuming symptoms in the
anorectal area are hemorrhoids and delay seeking treatment, or they
report rectal bleeding incorrectly, Sandler said.
"Tens of thousands of operations are done each year for
hemorrhoids," said Dr. Angus Watson, a colorectal surgeon at NHS
Highland in Inverness, UK, who wasn't involved in the study.
"It is important that patients receive high-quality and
cost-effective interventions that give them good quality of life and
hemorrhoid symptom control," he told Reuters Health by email.
SOURCE: https://bit.ly/2SRUNys American Journal of Gastroenterology,
online February 7, 2019.
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