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Health Care Resource Use and Associated Costs of Cyclic Vomiting Syndrome in the United States

October 10, 2022

In collaboration with colleagues from other institutions, David Levinthal, MD, PhD, director of the Neurogastroenterology and Motility Center at UPMC and assistant professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition at the University of Pittsburgh, evaluated the extent of U.S. health care resource use (HRU) and the direct cost burden of cyclic vomiting syndrome (CVS) among patients.

Individuals who suffer from CVS experience a disorder of gut-brain interaction that leads to frequent episodes of severe nausea and repetitive vomiting. Dr. Levinthal is one of only a handful of international CVS experts. His previous research focuses on CVS recognition and guidelines for treatment. According to Dr. Levinthal, adults with CVS almost always receive fragmented care, and a diagnostic delay of five to six years from the onset of symptoms is typical.

However, he stresses that recognition of CVS is key to treatment. Moreover, effective and inexpensive preventative treatments exist for most patients, such as amitriptyline/nortriptyline or topiramate. Dr. Levinthal’s most recent study examines the total cost burden of CVS. The results demonstrate that outpatient medications are only a small component of total costs, highlighting the importance of improving HRU via access to preventative treatments that would reduce patient suffering physically and financially. 

The study selected patients in the MarketScan Commercial and Medicare Supplemental databases with one or more inpatient (IP) or two or more outpatient (OP) claims for CVS between October 1, 2015, and June 30, 2019. Patients also had continuous insurance enrollment for at least 12 months before and at least 3 months after their first CVS diagnosis.1

Using propensity scores based on baseline characteristics, each patient with CVS was matched to non-CVS controls. The research team annualized HRU and costs to accommodate varying follow-up periods. Multivariable regressions further balanced CVS and non-CVS groups, and differences in HRU and costs between the matched cohorts were compared to quantify the direct cost burden of CVS.1

Results clearly showed that patients with CVS incurred significantly higher average HRU each year, with the largest differences occurring in emergency room visits and hospital IP stays.

Additionally, patients with CVS had significantly higher annual total health care costs with $57,140 in CVS expenses compared to the non-CVS expenses of $14,912, with IP spending as the main driver of the cost difference.

Total health care costs remained 4.1 times higher for patients with CVS relative to non-CVS controls, with IP costs 12.3 times higher, emergency room costs 5.8 times higher, OP visit costs 2.9 times higher, and OP pharmacy costs 1.5 times higher.1

Ultimately, this study demonstrates for the first time that newly diagnosed patients with CVS have greater health care utilization and higher costs than their non-CVS counterparts, indicating a large economic burden of CVS on the U.S. health care system.

Read the full study here.


Chen, Y. & Song, X. & Winer, I. & Smith, P. & Bhandari, S. & Almansa, C. & Richmond, C. & Venkatesan, T. & Levinthal, D. (2022). Healthcare Resource Use and Associated Costs of Cyclic Vomiting Syndrome in the US. Gastro Hep Advances. 1. 10.1016/j.gastha.2022.06.013.