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Background <p>Chronic constipation reduces quality of life and imposes a significant economic burden. The introduction of novel agents in Japan has expanded treatment options. This study aimed to establish a cost-effective treatment strategy, considering clinical utility and patient satisfaction.</p> Methods <p>Nine treatment strategies were developed, each consisting of three consecutive treatment options selected from five drugs: magnesium oxide (MgO), lubiprostone, linaclotide, elobixibat, and PEG formulation. A Markov state-transition model was used to estimate costs and outcomes. Effectiveness data were derived from a network meta-analysis of spontaneous bowel movements within 24&#xa0;h (SBM24) using domestic trial data. Expected costs and quality-adjusted life years (QALYs) were calculated from the healthcare payer’s perspective.</p> Results <p>In the network meta-analysis, lubiprostone had the highest relative risk for SBM24 (2.36), followed by lactulose (1.84) and elobixibat (1.71). Compared to MgO, the lubiprostone–elobixibat–PEG formulation strategy had additional costs of JPY 8,069.5 and a QALY gain of 0.0710, resulting in an incremental cost-effectiveness ratio (ICER) of JPY 113,709/QALY—well below the willingness-to-pay threshold of JPY 5–6 million/QALY. All strategies had ICERs below JPY 200,000/QALY, indicating favorable cost-effectiveness. Sensitivity analyses confirmed that the lubiprostone–elobixibat–PEG formulation strategy remained the most cost-effective, demonstrating its robustness.</p> Conclusions <p>The lubiprostone–elobixibat–PEG formulation strategy showed the most favorable cost-effectiveness profile. In addition, novel treatment options, including lubiprostone, linaclotide, elobixibat, and PEG formulation, were found to be cost-effective compared to MgO. Further research is warranted to confirm these findings and support their application in clinical practice.</p>

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Cost–utility analysis of treatment strategies for chronic constipation in Japan

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Mariko Hojo,
  • Ataru Igarashi,
  • Ayako Shoji,
  • Akihito Nagahara

摘要

Background

Chronic constipation reduces quality of life and imposes a significant economic burden. The introduction of novel agents in Japan has expanded treatment options. This study aimed to establish a cost-effective treatment strategy, considering clinical utility and patient satisfaction.

Methods

Nine treatment strategies were developed, each consisting of three consecutive treatment options selected from five drugs: magnesium oxide (MgO), lubiprostone, linaclotide, elobixibat, and PEG formulation. A Markov state-transition model was used to estimate costs and outcomes. Effectiveness data were derived from a network meta-analysis of spontaneous bowel movements within 24 h (SBM24) using domestic trial data. Expected costs and quality-adjusted life years (QALYs) were calculated from the healthcare payer’s perspective.

Results

In the network meta-analysis, lubiprostone had the highest relative risk for SBM24 (2.36), followed by lactulose (1.84) and elobixibat (1.71). Compared to MgO, the lubiprostone–elobixibat–PEG formulation strategy had additional costs of JPY 8,069.5 and a QALY gain of 0.0710, resulting in an incremental cost-effectiveness ratio (ICER) of JPY 113,709/QALY—well below the willingness-to-pay threshold of JPY 5–6 million/QALY. All strategies had ICERs below JPY 200,000/QALY, indicating favorable cost-effectiveness. Sensitivity analyses confirmed that the lubiprostone–elobixibat–PEG formulation strategy remained the most cost-effective, demonstrating its robustness.

Conclusions

The lubiprostone–elobixibat–PEG formulation strategy showed the most favorable cost-effectiveness profile. In addition, novel treatment options, including lubiprostone, linaclotide, elobixibat, and PEG formulation, were found to be cost-effective compared to MgO. Further research is warranted to confirm these findings and support their application in clinical practice.