Clinical

Burden of Disease

2007

Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence

J G Williams, S E Roberts, M F Ali, W Y Cheung, D R Cohen, G Demery, A Edwards,M Greer, M D Hellier, H A Hutchings, B Ip, M F Longo, I T Russell, H A Snooks and JC Williams

Gut 2007;56;1-113

Introduction

This document has been commissioned by the British Society of Gastroenterology. It is intended to draw together the evidence needed to fill the void created by the absence of a national framework or guidance for service provision for the management of patients with gastrointestinal and hepatic disorders. It sets out the service, economic and personal burden of such disorders in the UK, describes current service provision, and draws conclusions about the effectiveness of current models, based on available evidence. It does not seek to replicate existing guidance, which has been produced for upper and lower gastrointestinal cancers, hepatobiliary and pancreatic disorders, and many chronic disorders of the gut. It does, however, draw on evidence contained in these documents. It is intended to be of value to patient groups, clinicians, managers, civil servants, and politicians, particularly those responsible for developing or delivering services for patients with gastrointestinal disorders.

The burden of gastrointestinal and liver disease is heavy for patients, the NHS, and the economy, with gastrointestinal disease the third most common cause of death, the leading cause of cancer death, and the most common cause of hospital admission. There have been increases in the incidence of most gastrointestinal diseases which have major implications for future healthcare needs. These diseases include hepatitis C infections, acute and chronic pancreatitis, alcoholic liver disease, gallstone disease, upper gastrointestinal haemorrhage, diverticular disease, Barrett’s oesophagus, and oesophageal and colorectal cancers. Socioeconomic deprivation is linked to a number of gastrointestinal diseases, such as gastric and oesophageal cancers, hepatitis B and C infections, peptic ulcer, upper gastrointestinal haemorrhage, as well as poorer prognosis for colorectal, gastric, and oesophageal cancers. The burden on patients’ health related quality of life has been found to be substantial for symptoms, activities of daily living, and employment, with conditions with a high level of disruption to sufferers’ lives found to include: gastro-oesophageal reflux disease, dyspepsia, irritable bowel syndrome, anorectal disorders, gastrointestinal cancers, and chronic liver disease. However, impact on patients is neither fully nor accurately reflected in routine mortality and activity statistics and although overall, the burden of gastrointestinal disease on health related quality of life in the general population appears to be high, the burden is neither systematically nor comprehensively described.

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PRISM project 9608

Report prepared by - Dr Grant Lewison
Second Report
26 June 1997
The Wellcome Trust

Summary

This study was in three main parts. In the first part, citations to gastroenterology papers (GASTR) supported by the British Society of Gastroenterology and British Digestive Foundation were shown to be higher than to papers supported by other charities by a factor of about two, and higher than to papers without a funding body by a factor of about three. In the second part, citations to the 12 925 UK gastroenterology papers by US patents were examined. The GASTR papers were cited more often if they were basic rather than clinical, and if they had more authors or more funding bodies, but not if they were co-authored by different labs. The citing patents had 14% of UK inventors but only 9% of UK assignees, suggesting a relative failure of UK firms to exploit UK gastroenterological science.

The third part of the study was concerned with the burden of gastrointestinal (GI) disease. Two principal components were studied in depth: absence from work because of early death, long-term disability, and short-term illness; and NHS costs. Early deaths, mainly from cancer, are the main contributor to the first component and they cause an annual loss of production of the order of £2.2 billion. Long-term disability is seldom due to GI causes and may account for about £0.8 billion, but possibly one fifth of short-term sickness absence is so attributable and may cause losses of the order of £2.0 billion. The NHS costs total about £3.0 billion per year, of which 45% is in-patient costs, and 27% drugs dispensed under the NHS. The overall burden is thus some £8 billion per year, or about 1.3% of GDP. There is no evidence that this burden is declining, as it is for some other causes of illness.