Pharmacoeconomic impact of low-dose macrogol 3350 plus electrolytes compared with lactulose in the management of chronic idiopathic constipation among ambulant patients in Belgium

Objective: To estimate the economic impact of using low-dose macrogol 3350 plus electrolytes (macrogol 3350; Movicol((R))) compared with lactulose in the treatment of chronic idiopathic constipation among ambulant patients in Belgium, from the perspectives of the Sick Fund and patients. The analysis considered separately the economic impact of (a) a specialist and (b) a general practitioner (GP) initiating treatment. Design and setting: This was a modelling study performed from the perspective of Belgium's Sick Fund and patients. Methods: Estimates of healthcare resource utilisation in a previously reported UK model depicting the management of chronic idiopathic constipation with either macrogol 3350 and lactulose over 3 months were replaced with Belgian estimates derived from a panel of 11 gastroenterologists and 11 GPs. The model was used to estimate the expected 3-monthly Sick Fund cost and direct cost to patients of using either laxative to manage chronic idiopathic constipation in Belgium. Main outcome measures and results: According to our model, 53% and 24% of patients are expected to be successfully,treated with macrogol 3350 and lactulose, respectively. Additionally, using macrogol 3350 instead of lactulose is expected to reduce the 3-monthly Sick Fund cost in approximately 55% of patients and afford a cost-effective treatment in the remaining patients. Furthermore, the 3-monthly Sick Fund cost of managing chronic idiopathic constipation among ambulant patients is expected to be reduced by approximately 50% if patients were initially treated by a GP instead of a specialist. In Belgium, laxatives are paid for by patients. Despite the difference in their acquisition cost, treating chronic idiopathic constipation with either macrogol 3350 or lactulose was found to be cost neutral from a patient's perspective. Conclusions: The true cost of managing chronic idiopathic constipation is impacted on by a broad range of resources and not only laxative acquisition costs. This study indicated that managing ambulant patients with chronic idiopathic constipation with macrogol 3350 instead of lactulose is a cost-effective treatment from the Sick Fund's perspective and cost neutral from a patient's perspective.