Health Care Utilization, Costs, and the Burden of Disease Related to Chronic Pancreatitis in the United States

Abstract

Introduction: Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas that results in the slow destruction of pancreatic parenchyma with ensuing fibrosis. Chronic pancreatitis is a major cause of morbidity with associated localized complications, exocrine insufficiency, diabetes and severe intractable pain. There are limited data on the rate and costs associated with inpatient admissions for CP. The aim of this study was to analyze a national database of U.S. hospitals to determine the incidence and inpatient costs of associated with CP. Methods: We analyzed the National Inpatient Sample Database (NIS) for all subjects in which CP (ICD code 577.1) was the principal discharge diagnosis during the period from 1997-2012. Review of ICD-9 codes did not reveal a separate designation for acute-on-chronic pancreatitis. The NIS is the largest publicly available, all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each year. A Chi-squared test was applied to analyze the number of hospital discharges, the length of hospital stay (LOS) and the related hospital costs over the study period. Results: There were 21815 admissions with a principal discharge diagnosis of CP as in 1997 compared to 14195 in 2012 (p < 0.001). The rate of discharge per 100000 persons decreased from 8±0.4 to 4.5 ±0.1 (p < 0.001 Figure 1) over the same time period. Moreover, the mean LOS decreased from 6.2 days to 5.0 days, reflecting a 19.3 % change (p < 0.001). However, during this period the mean hospital costs increased by 183.9 % from $ 12725 per patient in 1997 to $36138 per patient in 2012 (p < 0.001, Figure 2). Interestingly, the in-hospital mortality rate did not change significantly, with a decremental trend from 0.81 % in 1997 to 0.59% in 2012 (p= 0.21 NS).Figure 1Figure 2Conclusion: The number of inpatient admissions and rate of discharge for CP has markedly decreased over the last 16 years. In contrast, there has been a significant increase in hospital costs related to CP however there has been no significant change in the inpatient mortality rates. These trends may reflect improvement in the outpatient management of CP patients and increase in overall cost of healthcare, but further studies are needed to confirm this association.