STOOL Stepped Treatment of Older adults On Laxatives
From January 2003 to May 2006
Project Leader(s): John Bond
Sponsors: NHS HTA
A systematic review of the effectiveness of laxatives found weak evidence that laxatives can improve frequency and consistency of stools and symptoms for older people with chronic constipation. It highlighted large variations in the cost of treatment for chronic constipation; the lack of evidence on the different classes of laxative; and the absence of good evidence on effectiveness based on ambulant older people living at home. Stepped management of constipation was proposed.
The study addressed the following key questions:
What is the comparative clinical and cost effectiveness of bulk forming, stimulant and osmotic laxatives?
What is the comparative clinical and cost effectiveness of using combinations of bulk forming and stimulant laxatives; bulk-forming and osmotic laxatives; and stimulant and osmotic laxatives?
Given that the clinical effectiveness of these agents will be influenced by patient adherence to treatment protocols, a secondary question was:
Specific objectives are:
How do patients use laxatives?
To investigate the clinical and cost effectiveness of bulk-forming, stimulant and osmotic laxatives.
- To investigate the clinical and cost effectiveness of adding a second type of laxative agent in the treatment of patients whose constipation is not resolved by a single agent.
- To describe the adherence by patients to treatment protocols and to estimate its impact on cost effectiveness.
This study attempted to trial stepped management of the prescription of laxatives to compare the relative cost effectiveness of three classes: bulk-forming, stimulant and osmotic laxatives. The trial was unsuccessful because patients' preferences militated against participation in a trial. A small qualitative study increased our understanding of the meaning and experience of constipation for patients and health professionals.