Cost Effectiveness and Compliance With ACG Guidelines in the Diagnosis of Acute Pancreatitis: A Comparison Between a University and Private Tertiary Hospital

Abstract

Introduction: The American College of Gastroenterology (ACG) developed guidelines to diagnose acute pancreatitis. Our study looks at whether or not healthcare providers at our primary university hospital (UH) and private tertiary hospital (PTH) follow these guidelines to determine if imaging is necessary. Furthermore, the Bedside Index for Severity in Acute Pancreatitis (BISAP) can be used to identify patients at risk for in-hospital mortality early in their admission and helps determine if initial imaging will be beneficial. Methods: This is a retrospective cohort study that includes 54 patients from our PTH and 70 patients from our UH diagnosed with acute pancreatitis from 01/2010 to 01/2011. These patients were randomly selected from a list of acute pancreatitis cases for that year. Each of these cases was categorized into 1 of 4 clinical scenarios to evaluate compliance with the ACG guidelines. BISAP scores were calculated for each patient to determine the severity of pancreatitis. The number of cases noncompliant with the ACG guidelines and those patients who had non-severe pancreatitis based on a low BISAP score were summed. It was then determined, based on these cases, how much money was unnecessarily spent on imaging. Results: The overall compliance rate was 28% and 71% at the PTH and UH respectively. UH clinicians were significantly more compliant compared to the PTH (p<0.0001). Of patients with lower BISAP scores (<2), and therefore non-severe pancreatitis, noncompliance was 29% at UH vs. 69% at the PTH (p<0.0001). Based on the national average cost of a CT scan, savings of $36,856 and $18,826 would have been achieved at the PTH and UH, respectively. However, taking into account the number of cases of acute pancreatitis seen at each hospital that year, these savings could be extrapolated to $279,150 and $43,300 at PTH and UH, respectively. Conclusion: Adherence to the ACG guidelines is poor for both hospitals. However, our UH did significantly better than our PTH. This could be explained by closer adherence to newer guidelines in a primarily teaching hospital with residents working in the emergency department. As demonstrated with lower BISAP scores, there is lower mortality and therefore no need for imaging. The savings above reflect how much money each hospital could have saved by simply eliminating a single CT scan for each patient.