Direct costs for nonsurgical management of Chronic Pancreatitis in a tertiary care teaching hospital

ABSTRACT

Background: Chronic pancreatitis (CP) is a leading cause of hospitalization among gastrointestinal diseases resulting in considerable financial burden to patients. However the direct costs for nonsurgical management in CP remains unexplored.

Methods: A cross sectional study was carried out (2011–14) in the Department of Gastroenterology, Kasturba Hospital, Manipal, India. Demographic and clinical data on laboratory investigations, interventions and follow up were obtained from the medical records department. Item costs were derived from the hospital electronic billing section. Cost was expressed as median annual cost per patient.

Results: 65 (male 48; 73.8%) patients were included. Their median age was 31 (range 12–68) years. The annual median (IQR) total cost per patient was INR 88,892 (70,550.5–116,004); [USD 1410(1119–1841); € 1155(916–1507)], comprising of INR 61,089 (39,102.5–90,360.5) [USD 970 (621–1434); € 793(508–1174)] for outpatient management and INR 32,450 (11,016–46,958) [USD 515 (175–745); €421(143–610)] for hospitalization. 69.5% of the treatment cost was attributed to outpatient treatment. Drugs contributed to 54%, hospitalization incurred 30.5%, investigations 12% and professional fees (3.5%) of the total cost. Pancreatic enzyme replacement therapy (PERT) cost contributed to three-quarters of drug therapy. Use of rabeprazole as against pantoprazole reduced the overall annual cost of therapy by 4%.

Conclusions: This study depicts the first nonsurgical management of accrued direct costs associated with CP due to expensive medications. Due to the high cost for PERT, its usefulness needs proper validation by cost benefit analysis.

KEYWORDS:

• Chronic pancreatitis
• pharmacoeconomics
• direct cost
• pancreatic enzyme replacement therapy
• cost of illness

Acknowledgment

The authors are thankful to Manipal University, medical records department and the staff of hospital administration, finance and billing section of Kasturba Hospital Manipal for the facilities provided for data access. The authors are also thankful to Dr. Shiran Shetty and the entire staff of Department of Gastroenterology, Kasturba Hospital, Manipal.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Grants and financial support

Nil.

Conflicts of interest

None to disclose.

Authors’ contributions

Nagesh Kamat (NK), Surulivel Rajan Mallayasamy (SRM), Ganesh Pai (GP) designed the study. NK collected data, performed statistical analyses along with Asha Kamath (AK) and interpreted the results with Rajasulochana S (RS). NK drafted the article. SRM, AK, RS and GP provided vital inputs. The final manuscript was reviewed and approved by all the authors.

Compliance with Ethical Standards

For this type of study, formal consent is not required, however our study received institutional ethics committee approval.

Supplemental data

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.