Skip to main content
Open access
Research Article
16 November 2023

Gastrointestinal manifestations in pediatric and adult patients with Rett syndrome: an analysis of US claims and physician survey data

Abstract

Aim: Patients with Rett syndrome (RTT) experience gastrointestinal (GI) manifestations. This study aimed to describe the prevalence of GI manifestations and the associated medical costs in patients with RTT in the USA. Patients & Methods: The study combined an insurance claims database analysis with a survey of 100 physicians experienced in RTT management. Results: GI manifestations affected 43.0% of 5940 patients, with increased prevalence in pediatric patients (45.6%) relative to adult patients (40.2%). Annualized mean medical cost of managing GI manifestations was $4473. Only 5.9–8.2% of neurologists and pediatricians ranked GI symptom management among the five most important treatment goals. Conclusion: Patients with RTT experience a high burden of GI manifestations, which translate to considerable medical costs. Importantly, the prevalence of GI manifestations was likely underestimated in this study, as only those symptoms which resulted in a healthcare encounter were captured.

Tweetable abstract

Rett syndrome (RTT) is a rare and debilitating genetic disease. By combining claims data with a physician survey, we report on the prevalence, costs, and physicians' management strategies of gastrointestinal symptoms associated with RTT.

Plain language summary

What is this article about?

Rett syndrome (RTT) is a rare and severe neurodevelopmental disorder that almost exclusively affects girls and women. Patients with RTT develop debilitating symptoms that evolve throughout their lifespan, rendering them severely disabled. Gastrointestinal (GI) manifestations are common in patients with RTT and add to patient burden and caregiver concerns. This study described the prevalence of GI manifestations of RTT and the associated physician perspectives and medical costs in pediatric (<18 years) and adult patients.

What were the results?

In an analysis of insurance claims data from the USA, GI manifestations were found to affect 43.0% of all patients and were slightly more common in pediatric patients (45.6%) relative to adult patients (40.2%). Mean medical costs of managing GI manifestations amounted to $4473 per patient per year (PPPY) and were somewhat higher in pediatric ($5530 PPPY) than adult ($3341 PPPY) patients. In a survey of 100 US physicians experienced in RTT management, only 5.9% of neurologists and 8.2% of pediatricians ranked management of GI manifestations among the five most important RTT treatment goals.

What do the results of the study mean?

This study suggests that both pediatric and adult patients with RTT experience a high burden of GI manifestations, which are also associated with considerable medical costs. It is possible to proactively address GI manifestations as part of current routine care, although management of GI symptoms remains under-represented as an RTT treatment goal among treating physicians.

Supplementary Material

File (supplementary tables.xlsx)

References

Papers of special note have been highlighted as: • of interest
2.
Ip JPK, Mellios N, Sur M. Rett syndrome: insights into genetic, molecular and circuit mechanisms. Nat. Rev. Neurosci. 19(6), 368–382 (2018).
3.
Anderson A, Wong K, Jacoby P, Downs J, Leonard H. Twenty years of surveillance in Rett syndrome: what does this tell us? Orphanet. J. Rare Dis. 9(1), 87 (2014).
• Provides an overview of real-world clinical outcomes and survival in a large sample of patients with Rett syndrome (Australian and international data).
4.
Tarquinio DC, Hou W, Neul JL et al. The changing face of survival in Rett syndrome and MECP2-related disorders. Pediatr. Neurol. 53(5), 402–411 (2015).
• Provides information on survival and risk factors for mortality in patients with Rett syndrome (US data).
5.
Freilinger M, Bebbington A, Lanator I et al. Survival with Rett syndrome: comparing Rett's original sample with data from the Australian Rett Syndrome Database. Dev. Med. Child Neurol. 52(10), 962–965 (2010).
6.
Baikie G, Ravikumara M, Downs J et al. Gastrointestinal dysmotility in Rett syndrome. J. Pediatr. Gastroenterol. Nutr. 58(2), 237–244 (2014).
• Provides clinical recommendations on the management of gastrointestinal symptoms in patients with Rett syndrome.
7.
Fu C, Armstrong D, Marsh E et al. Consensus guidelines on managing Rett syndrome across the lifespan. BMJ Paediatr. Open. 4(1), e000717 (2020).
• Provides clinical recommendations on the management of gastrointestinal symptoms in patients with Rett syndrome.
8.
Motil KJ, Khan N, Coon JL et al. Gastrointestinal health questionnaire for Rett Syndrome: tool development. J. Pediatr. Gastroenterol. Nutr. 72(3), 354–360 (2021).
9.
Quan H, Sundararajan V, Halfon P et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 43(11), 1130–1139 (2005).
10.
Chahil G BP. Rett Syndrome. StatPearls [Internet] (2020).
11.
Jedele KB. The overlapping spectrum of Rett and Angelman syndromes: a clinical review. Semin. Pediatr. Neurol. 14(3), 108–117 (2007).
12.
Motil KJ, Caeg E, Barrish JO et al. Gastrointestinal and nutritional problems occur frequently throughout life in girls and women with Rett syndrome. J. Pediatr. Gastroenterol. Nutr. 55(3), 292–298 (2012).
13.
Cianfaglione R, Clarke A, Kerr M, Hastings RP, Oliver C, Felce D. A national survey of Rett syndrome: age, clinical characteristics, current abilities, and health. Am. J. Med. Genet. A. 167(7), 1493–1500 (2015).
15.
Us Bureau of Labor Statistics. CPI Inflation Calculator (2023). www.bls.gov/data/inflation_calculator.htm
16.
Hendrie D, Bebbington A, Bower C, Leonard H. Measuring use and cost of health sector and related care in a population of girls and young women with Rett syndrome. Res Autism Spectr Disord. 5(2), 901–909 (2011).
17.
Peron A, Canevini MP, Ghelma F, Arancio R, Savini MN, Vignoli A. Phenotypes in adult patients with Rett syndrome: results of a 13-year experience and insights into healthcare transition. J. Med. Genet. 59(1), 39–45 (2022).