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Burden and Cost of Outpatient Hemorrhoids in the United States Employer-Insured Population, 2014

Yang, Jeff Y., BA, BS1; Peery, Anne F., MD, MSCR2; Lund, Jennifer L., PhD1; Pate, Virginia, MS1; Sandler, Robert S., MD, MPH1,2

American Journal of Gastroenterology: May 2019 - Volume 114 - Issue 5 - p 798–803
doi: 10.14309/ajg.0000000000000143
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INTRODUCTION: Although hemorrhoids are a common indication for seeking health care, there are no contemporary estimates of burden and cost. We examined data from an administrative claims database to estimate health care use and aggregate costs.

METHODS: We conducted a cross-sectional study using the MarketScan Commercial Claims and Encounters Database for 2014. The analysis included 18.9 million individuals who were aged 18–64 and continuously enrolled with prescription coverage. Outpatient hemorrhoid claims were captured using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes in the first position, as well as Common Procedural Terminology codes. Prescription medications were identified using National Drug Codes. Annual prevalence and costs were determined by summing gross payments for prescription medications, physician encounters, and facility costs. We used validated weights to standardize annual cost estimates to the US employer-insured population.

RESULTS: In 2014, we identified 227,638 individuals with at least one outpatient hemorrhoid-related claim (annual prevalence, 1.2%). Among those, 119,120 had prescription medication claims, 136,125 had physician claims, and 28,663 had facility claims. After standardizing, we estimated that 1.4 million individuals in the US employer-insured population sought care for hemorrhoids in 2014 for a total annual cost of $770 million. This included $322 million in physician claims, $361 million in outpatient facility claims, and $88 million in prescription medication claims.

CONCLUSIONS: The estimated economic burden of hemorrhoids in the employer-insured population approaches $800 million annually. Given the substantial and rising burden and cost, expanded research attention should be directed to hemorrhoidal etiology, prevention, and treatment.

1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

2Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.

Correspondence: Robert S. Sandler, MD, MPH. E-mail: rsandler@med.unc.edu.

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A58

Received September 30, 2018

Accepted December 20, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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