Pid3: Trends in Inpatient Costs for Acute Pancreatitis in the United States

Abstract

Although the care of patients with pancreatitis‐related complications is estimated to be much more resource‐intensive than that provided to other critically‐ill patients, information on the cost of acute pancreatitis is limited. OBJECTIVES: To examine trends in the incidence and cost of acute pancreatitis‐related hospitalizations in the United States, and to ascertain patient disposition at discharge to evaluate the extent to which costs may extend beyond the initial hospitalization. METHODS: Data were obtained from the 1995–1997 Health care Cost and Utilization Project database. ICD‐9‐CM code 577.0 was used to identify hospitalizations with a primary or secondary diagnosis of acute pancreatitis. Patient demographics, length of stay (LOS), total charges (in constant 1995 dollars), and discharge status were assessed. RESULTS: Between 1995 and 1997, the number of acute pancreatitis‐related hospitalizations increased by 9.1% from 241,178 to 263,136. During that period, the average LOS decreased by 9.5% from 8.4 days to 7.6 days and the mean hospital charges decreased by 4.9% from $19,222 to $18,280. Using LOS 15 days as a proxy for severity, severe acute pancreatitis‐related hospital discharges decreased from 30,444 in 1995 to 27,839 in 1997. During that period, the average LOS remained constant (28.9–28.4 days) and the mean charges increased from $77,572 to $82,043. Nationwide, the projected pancreatitis‐related inpatient charges have increased from $4.6 to $4.8 billion. Despite representing 12% of admissions, severe acute pancreatitis‐related charges represented 49% of all acute pancreatitis‐related inpatient charges. 38–41% of patients were discharged to another facility, suggesting that these cost estimates are conservative. CONCLUSIONS: Acute pancreatitis is a major financial burden on health care systems due to high inpatient costs and frequent need for medical care that extends beyond the hospital stay. Despite a reduction in charge per case, total inpatient charges of pancreatitis have increased to rising incidence.

Incidence, Resource Use, and Outcome of Acute Pancreatitis With/Without Intensive Care

“…Similar findings have been reported in the United States but only in abstract form. 12 The incidences of severe AP and acute organ dysfunction in our study are consistent with prior reports: approximately 7% to 20% of patients with AP are severe 3,4,27 and 52% to 87% of patients with severe AP have acute organ dysfunction. 28Y30 Increasing age, higher severity of illness, and a greater extent of pancreatic necrosis are associated with the development of acute organ dysfunction, 31 which is the major determinant of mortality.…”

“…13 Data on the relative contributions of mild and severe cases to the overall health care burden of AP can be helpful for resource allocation and health care planning. 12 Although individual patients with mild AP used less resources, had a shorter hospital stay, and incurred lower hospital charges (Tables 2 and 3), they comprised most (80%) of the patients with AP and therefore accounted for a greater proportion of the total hospital days and charges. On the other hand, those with ICU admission, albeit comprising only one tenth of the patients, accounted for 22% of the total hospital stay and 40% of the total hospital charges, reflecting the intense resource use associated with them (Table 3).…”

“…6,7 Whereas the overall case-fatality rate of AP has been decreasing over the decades, 1,2,4,8 severe cases requiring intensive care still carry a high mortality (20%Y50%) 6,9,10 and consume a large proportion of resource use and costs. 9,11,12 For example, in a database study in the United States, the inpatient charges for severe cases accounted for nearly half (49%) of all AP-related inpatient charges. 12 The epidemiological data of AP remain limited in developing countries.…”

“…9,11,12 For example, in a database study in the United States, the inpatient charges for severe cases accounted for nearly half (49%) of all AP-related inpatient charges. 12 The epidemiological data of AP remain limited in developing countries. 13Y15 Prior studies on resource use or hospital charges of AP are confined to single institutions 10 or critical care settings, 9 limiting their generalizability.…”

“…13Y15 Prior studies on resource use or hospital charges of AP are confined to single institutions 10 or critical care settings, 9 limiting their generalizability. Although 2 populationbased studies in the United States have reported on resource use and hospital charges of AP, one is only presented in abstract form 12 and the other performed without discrimination of severe cases. 5 In Taiwan, a compulsory and universal National Health Insurance (NHI) program has been initiated by the government since 1995.…”