(Reuters Health) - Just among U.S. adults with employer insurance, non-surgical hemorrhoid treatment costs at least US$770 million annually, suggests a study that concludes this common complaint needs more attention.
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 US$770 million. This includes US$322 million in physician claims, US$361 million in outpatient facility claims and US$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 US$2.4 billion in expenses.
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 US$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.