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IBS is considered 1 of the most expensive conditions in gastroenterology.
Peppermint oil could be a cost effective new treatment for irritable bowel syndrome (IBS), according to new research.
A team, led by Zsa Zsa R. M. Weerts, MD, MSc, Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, assessed the cost-effectiveness of peppermint oil when compared to placebo for patients with IBS.
IBS often leads to high health care costs because of increased numbers of consultants, emergency room visits, hospitalizations, and prescribed medication compared to patients without IBS. IBS patients are also more frequently absent from work or impaired from work.
One option to reduce costs could be treatment with peppermint oil.
Recently, investigators found small intestinal peppermint oil was therapeutically superiority over placebo for IBS.
However, there is limited data regarding the cost-effectiveness of peppermint oil in this patient population.
In the multicenter, placebo-controlled, double-blind randomized control trial, the investigators examined patients with IBS between 18-75 years at 4 Dutch hospitals, 1 academic with a combined secondary/tertiary care function, and 3 secondary care.
The final analysis included 126 of the 189 identified patients, 64 patients in the placebo group and 62 patients treated with small-intestinal release peppermint oil.
Patients included in the study had a mean daily worst abdominal pain score of at least 3 during a 2 week run-in period. Each patient was treated with either 182 mg of small-intestinal release peppermint oil in enteric-coated soft gel capsules, ileocolonic release peppermint oil or placebo.
The 2 week run-in period was followed by a six month follow-up period with no study treatments. Patients were also asked to refrain from any lifestyle changes and new treatments during the duration of the study.
The investigators sought primary outcomes of the incremental cost-effectiveness ratio (ICER), which was calculated as the difference in quality adjusted life years (QALY) between peppermint oil and placebo over the 8 week treatment period.
The costs analyzed included all IBS-related direct costs, including outpatient consultations, general practice consultation, dietician, and mental health care and indirect costs, which can including absenteeism, presenteeism, and impaired unpaid work.
The cost analysis did not include figures from comorbidities or medical expenses unrelated to IBS.
While patients treated with the peppermint oil did experience some improvements in quality-of-life measures, it was not considered statistically significant in comparison to the placebo group.
On the other hand, costs were significantly less for the treatment arm in direct costs, mainly attributed to lower mental health costs.
Indirect costs, however, were similar, with the peppermint oil group having more productivity loss in unpaid work.
The overall incremental cost savings for the peppermint group was $55.26 more, with an incremental corrected QALY gain of 0.004 compared to the placebo group.
“The results show that small-intestinal release peppermint oil may be considered cost-effective compared to placebo during an eight-week treatment, from a societal perspective at a conservative WTP-threshold of ($13.81) per QALY,” the authors wrote. “However, there is an uncertainty surrounding the incremental cost-effectiveness ratios.”
While the initial results are positive, the investigators said more research is needed to fully understand whether peppermint oil can be a viable and cost effective treatment for IBS.
The study, “A trial-based economic evaluation of peppermint oil for the treatment of irritable bowel syndrome,” was published online in the United European Gastroenterology Journal.