Are probiotics worth the cost to prevent infection after a colon removal surgery?
A new UCLA Health study found that taking an 8-strain probiotic daily may reduce the risk of pouchitis, a common inflammatory condition that occurs after colon removal surgery for ulcerative colitis, but the treatment may not be worth the cost depending on a patient’s likelihood of flare-ups.
The study, published in the journal Gastro Hep Advances, is the first to evaluate the cost-effectiveness of the probiotic treatment, which was shown in previous studies to be effective at preventing the initial onset of and the reoccurrence of pouchitis. The UCLA study affirmed that the probiotic formulation was effective at preventing pouchitis compared to patients taking no probiotics but found that the cost to third-party payers may outweigh those benefits in most cases unless the cost of the probiotic formulation is lowered.
“Our findings highlight that while probiotic treatments can reduce the risk of this complication, their high costs limit their overall value for most patients,” said Dr. Gaurav Syal, study lead author and inflammatory bowel disease gastroenterologist at UCLA. “Our analysis can help guide shared decision-making between patients, clinicians and payers to ensure resources are used where they can provide the most benefit.”
Pouchitis is a common complication experienced by patients who have had their colon and rectum removed due to ulcerative colitis. Surgeons replace the rectum with a pouch made of the patient’s small intestine. The procedure allows patients to go to the bathroom in a mostly normal way rather than having to connect their small intestine to an external bag to excrete waste.
Pouchitis can develop if this internal pouch becomes inflamed, leading to several uncomfortable symptoms such as frequent and urgent bowel movements, bloody stools and abdominal pain among others. This condition is typically treated with a short course of antibiotics. Some patients can experience recurring pouchitis.
The UCLA study sought to determine whether a daily probiotic treatment using 8-strains of bacteria to prevent the development of pouchitis is worth the cost to third-party payers such as Medicare, Medicaid and private insurance companies.
Using a computer model that assessed the risk of initial development and reoccurrence of pouchitis over a two-year period, the study found that the daily probiotic treatment was only cost-effective for patients who have frequent relapses of pouchitis (two or more incidents per year) but was not cost effective for patients with infrequent relapse or for preventing the first onset of this complication compared to patients who do not undergo the probiotic treatment.
Over the two-year period, the model found:
- Probiotic treatment was nearly 10 times more expensive ($2,200 vs. $299) compared to no probiotic treatment for prevention of initial occurrence of pouchitis.
- Probiotic treatment was six times more expensive ($3,370 vs. $557) compared to no probiotic treatment for prevention of infrequent reoccurrence of pouchitis.
- However, probiotic treatment was cost-effective if a patient has two or more relapses of pouchitis per year.
Dr. Syal said the findings can help clinicians determine treatment options with patients as well as inform policymakers and third-party payers to determine how best to allocate healthcare funding.
Reference:
Gaurav Syal, Cost-Effectiveness of the Eight-Strain Probiotic in Primary and Secondary Prophylaxis of Pouchitis, Gastro Hep Advances, DOI:10.1016/j.gastha.2025.100776
