Key takeaways:
- ACG 2026 research found digital gut-brain therapy is the most cost-effective tool for managing IBS, adding 8.6–9.9 healthy days a year.¹
- Digital gut-brain therapy is best placed early in IBS care, including in primary care before gastroenterology referral.¹
- Modelled insurer savings were $475–$1,439 a year versus off-label antidepressants and over $8,500 versus on-label IBS prescriptions.¹
- Patients saved $773–$3,701 a year, driven by symptom relief and fewer sick days.¹
Digital gut-brain therapy saves insurers $475 to over $8,500 per IBS patient each year and adds 8.6 to 9.9 healthy days – a quality-of-life gain measured in full days of health – according to new cost-effectiveness research presented at ACG 2026.¹
For a condition as common as irritable bowel syndrome (IBS), those findings have important implications. When symptoms persist despite first-line care, patients can cycle through repeat visits, further investigations, and multiple prescriptions, with costs mounting along the way.² ³
With diet- or medication-based IBS management, annual costs can reach $3,176 per patient for insurers and $4,405 for patients.¹ So how do the available options compare, not just on cost, but on the health benefits they deliver?
Our new research compared the cost-effectiveness of IBS management options from both insurer and patient perspectives, looking at how costs stack up against the health benefits delivered.¹ The findings make a compelling case for considering digital gut-brain therapy earlier in the IBS care pathway.¹
IBS costs compared: gut-brain therapy, diet, and medication
In our one-year model, digital gut-brain therapy cost insurers less than a low FODMAP diet, off-label antidepressants, or on-label IBS prescriptions, with an estimated gain of 8.6 quality-adjusted healthy days based on real-world user data.¹ For patients, it also cost less than both diet and antidepressants.¹
The model followed a patient referred from primary care to general GI after over-the-counter options failed, using real-world data from 86,707 users.¹
Healthy days are quality-adjusted life years (QALYs) converted into days of full health, a more practical measure for a condition like IBS that isn’t life-threatening.¹
Here’s how annual costs compared by IBS subtype, with the biggest savings seen in IBS-C.¹
IBS-D¹
| IBS-D management option | Annual insurer cost* | Annual patient cost* |
|---|---|---|
| Digital gut-brain therapy | $1,234 | $3,394 |
| Low FODMAP diet | $1,718 | $4,405 |
| Off-label antidepressants | $1,399 | $3,404 |
*Per patient per year, in US dollars.
IBS-C¹
| IBS-C management option | Annual insurer cost* | Annual patient cost* |
|---|---|---|
| Digital gut-brain therapy | $2,316 | $3,364 |
| Low FODMAP diet | $3,073 | $4,405 |
| Off-label antidepressants | $3,176 | $4,124 |
*Per patient per year, in US dollars.
Compared with a low FODMAP diet and off-label antidepressants, digital gut-brain therapy saved insurers $757 and $860 a year per IBS-C patient, against $484 and $165 for IBS-D.¹
For patients with IBS-C, it cost $1,041 less than the diet and $760 less than antidepressants.¹
So, for constipation-predominant patients, gut-brain therapy offers some of the strongest value of any option in the model.
The cost rankings also held steady when the model was tested across 100,000 simulated patients, and the findings were similar for patients over 65 and in clinical trial data.¹
Applying this in practice: when to offer digital gut-brain therapy for IBS
Consider digital gut-brain therapy early in IBS management for patients with a confirmed IBS diagnosis, rather than saving it for refractory cases.¹ It’s particularly worth discussing with patients who have IBS-C, where the modelled savings and health gains were greatest.¹ In the model, savings were linked to earlier symptom relief, with fewer return visits and sick days.¹
Where gut-brain therapy fits in IBS care plans, from primary care to GI
ACG guidance suggests gut-directed psychotherapies for global IBS symptoms,⁴ and AGA recognises brain-gut behavioural therapies as part of quality IBS care.⁵ That means gut-brain therapy can sit alongside diet or medication, or be added later in the care pathway.
The new cost data gives a reason to consider starting earlier, even in primary care before a GI referral.¹ Imagine your clinic list if more patients had already started gut-brain therapy before they reached you, freeing your time for those who need further testing or more targeted intervention.
“The majority of IBS patients could be managed at their primary care provider level so what that tells us is that they’re often being pushed to specialised care and then they’re not necessarily being managed at specialised care level.”
– Dr. Simone Peters, Monash University & co-creator of Nerva
For patients who need more than gut-brain therapy alone, the model identified a low FODMAP diet or off-label antidepressants as the lower-cost next steps for insurers.¹ The picture looked different from the patient’s side, where on-label IBS prescriptions came out ahead because of their effectiveness.¹ Either way, diet and medication remain central to care for many patients, and gut-brain therapy is designed to work alongside them.
What the cost data means when you refer IBS patients to digital gut-brain therapy
When patients ask whether gut-brain therapy is worth the cost, this data gives you a clear answer: in the model, it lowered annual costs for insurers and patients while adding days of full health.¹ It also works alongside the diet and medication you may already have prescribed.
Even so, cost can make patients hesitant to try something new. With Nerva, if they finish the programme and it hasn’t helped, they can request a refund, and when you refer through our clinician form, they receive 25% off.
Frequently asked questions
Is gut-directed hypnotherapy for IBS covered by insurance?
Insurance coverage for gut-directed hypnotherapy programmes varies by plan. Some patients may be able to use HSA or FSA funds, subject to their plan’s rules, and a Letter of Medical Necessity from the referring clinician can support that claim.
Is digital gut-brain therapy cost-effective for IBS patients over 65?
Digital gut-brain therapy showed similar cost results in a separate real-world cohort of 7,048 users over 65, who gained 9.9 healthy days a year.¹ Adherence in this group was 86.6%, higher than the 80.0% seen across all users.¹
How long does gut-directed hypnotherapy take to work for IBS?
In a randomised trial of Nerva’s app-delivered gut-directed hypnotherapy, 81% of participants had a clinically meaningful drop in symptom severity (at least 50 points on the IBS-SSS, the standard IBS symptom score) at week 6, compared with 63% in the active control group.⁶
Is digital gut-directed hypnotherapy as effective as in-person therapy for IBS?
Digitally delivered gut-directed hypnotherapy has produced symptom response rates similar to those reported for face-to-face programmes.⁷ It can also reduce reliance on waitlists and scheduled appointments.
About this research: Dr. Eric Shah (University of Michigan) led this analysis with co-authors from Penn, Yale, Mass General, MUSC and UCLA, and Mindset Health research lead Claire Hall. It updates the authors’ published IBS cost model³ and was presented as a poster at ACG 2026 in Nashville.¹ Several authors disclose consulting for Mindset Health.
References
Shah E, Ahuja N, Deutsch J, Staller K, Sharma A, Shin A, Hall C. S1314 Cost-effectiveness of management options for irritable bowel syndrome: updated 2026 analysis. Am J Gastroenterol. 2026;121(10S1):S285. doi:10.14309/01.ajg.0001214508.36372.63
Peery AF, Murphy CC, Anderson C, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2024. Gastroenterology. Published online 2025.
Shah ED, Chang L, Salwen-Deremer JK, et al. Contrasting clinician and insurer perspectives to managing irritable bowel syndrome: multilevel modeling analysis. Am J Gastroenterol. 2021;116(4):748-757.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44.
Hung KW, Leiman DA, Kaza A, et al. AGA Institute quality indicator development for irritable bowel syndrome. Gastroenterology. 2025;168(3):612-622.e4.
Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol. 2025;120(2):440-448.
Peters SL, Gibson PR, Halmos EP. Smartphone app-delivered gut-directed hypnotherapy improves symptoms of self-reported irritable bowel syndrome: a retrospective evaluation. Neurogastroenterol Motil. 2023;35(4):e14533.
