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Letter: East–West differences in the economic impact of functional dyspepsia
Author(s) -
Mahadeva S.,
Goh K.L.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12443
Subject(s) - medicine , population , east asia , health care , selection bias , demography , environmental health , economic growth , geography , china , pathology , archaeology , sociology , economics
SIRS, We read with interest the recent article by Lacy et al., which estimates the direct and indirect costs of functional dyspepsia (FD) at US $18.4 billion for the entire US population or US $80 000 per 1000 US population for the year 2009. Although the study is limited by a selection bias of FD patients attending a tertiary centre and is not population-based, it provides current economic information using an internationally accepted Rome criteria. Having said that, the economic data reported in this study, and from other recent US-based studies, may have little global relevance. FD is equally prevalent in the East, but economic data remains sparse. A recent population-based study in South East Asia reported an estimated annual cost for uninvestigated dyspepsia of US $14 816.00 and US $59 282.20 per 1000 population in a rural and urban setting respectively. FD is the most common cause of dyspepsia in this region, and as the Rome criteria was used to identify study subjects, this Asian study suggests significant differences in the economic impact of FD in the East. Although healthcare systems in Asia and the West are known to differ, other factors may be responsible for the variation in the economic impact of FD. Self-medication practices and lower healthcare consultation rates among rural Asians, coupled with more aggressive management by clinicians in the US (40% had CT abdominal scans and 23% had surgery in Lacy et al.’s study), may lead to greater direct costs for FD in the West. Furthermore, socioeconomic differences between employees (81% in the US study vs. 27.7% in the Malaysian study with >US $ 10 000 annual income) are an obvious factor when considering indirect costs for FD due to work absenteeism. In short, the economic impact of FD appears to vary globally and it is likely that cultural, sociodemographic and clinical factors may be responsible for this difference.