Presence of Pancreatic Specialty Centers Is Associated With Increased Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

Abstract

Introduction: Exocrine pancreatic insufficiency (EPI) is a debilitating consequence for many chronic pancreatitis (CP) patients resulting in multiple nutritional deficiencies & clinical symptoms. Overall prevalence of EPI in CP is estimated to be approximately 35-50%. Pancreatic enzyme replacement therapy (PERT) is the mainstay of EPI treatment. The National Pancreas Foundation (NPF) has accredited 39 specialty pancreas centers (NPF-C) since 2015 at institutions nationwide to designate interdisciplinary referral centers for patients with pancreatic diseases. The aim of this study is to assess the effect of NPF-C on PERT prescriptions (PERT-Rx) for EPI in CP patients using a nationwide claims database. Methods: We performed a retrospective analysis of a national claims database (Symphony) of over 250 million patients in the US to identify an aggregated cohort of CP patients & further identify those CP patients with at least 3 PERT-Rx across manufacturers for 2017. CP patients & PERT-Rx were mapped using physician prescriber zip code. CP patients & PERT-Rx were stratified by zip code into 3 groups: NPF-C zip codes, zip codes within a 50 mile radius of an NPF-C, & zip codes over 50 miles from an NPF-C. Rates of PERT-Rx in CP patients in NPF-C zip codes were compared to the local surrounding 50 mile radius area zip codes & to zip codes over 50 miles to assess the effect of NPF-C on PERT-Rx using chi-square & ANOVA analyses (GraphPad Prism 7). Results: There were 163724 CP patients identified nationwide in 2017, of which 25927 had PERT-Rx (Overall treatment 15.8%). 1458 of 6376 (22.9%) CP patients treated for EPI in NPF-C zip codes received PERT-Rx, compared to 6733 of 44680 (15.1%) in the 50 mile radius surrounding NPF-C (chi-square p<0.0001) (Figure 1). PERT-Rx rates in NPF-C zip codes were significantly higher than in geographically near & remote locations (ANOVA p<0.0001). Rates of PERT-Rx in zip codes within 50 miles of NPF-C were numerically similar to those over 50 miles.11_A Figure 1. Rate of PERT Prescriptions by Chronic Pancreatitis Patient Group.Conclusion: Substantial gaps in the treatment of EPI in CP patients exist nationwide. Rates of PERT-Rx in CP patients were significantly higher in NPF-C zip codes compared to the surrounding areas & zip codes over 50 miles. The presence of pancreatic specialty centers may improve EPI care in CP. Additional interventions are needed to bridge these gaps & prevent the clinical sequelae of untreated EPI.