Pahomeanu Mihai Radu, Constantinescu Dalia Ioana, Diaconu Irina Ștefania, Corbu Dana Gabriela, Negreanu Lucian
Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Gastroenterology and Internal Medicine, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania.
Healthcare (Basel). 2023 Sep 7;11(18):2482. doi: 10.3390/healthcare11182482.
(1) Introduction: Acute pancreatitis (AP) remains a global burden of cost for healthcare services. We found a high degree of heterogeneity in cost-related reports and a scarcity of data regarding the cost of AP episodes in European and Asian populations. We aimed to estimate the median daily cost of hospitalisation (DCH) of AP in our population. Our secondary aims included estimating the total cost of hospitalisation (TCH) and the total cost of AP in Romania, as well as assessing the correlation between median DCH and ward, age, sex, length of stay (LoS), intensive care unit (ICU), outcome, severity, morphology, and aetiology of AP. (2) Material and methods: This retrospective cohort study included 1473 cases recruited from the electronic health records of the University Emergency Hospital of Bucharest. Statistical tests used included Kolmogorov-Smirnov, Kruskal-Wallis with post-hoc Dunn-Bonferroni, and Pearson correlation two-tailed. (3) Results: We found a median DCH of AP of USD 203.8 and a median TCH of USD 1360.5. The total yearly cost of AP in Romania was estimated at around USD 19 million. The majority of males with AP (61.8%) were mostly discharged as healed/ameliorated (83.8%); a majority had local complications (55.4%), which were mostly alcohol-related (35.1%). Regarding the aetiology, biliary-related AP was a cost driver, with significant statistical differences observed in all studied groups ( < 0.01). Morphology assessment revealed that acute necrotic collections were associated with high cost and meaningful disparities among the groups ( < 0.01). Cost was also associated with severity, with significant deviations among all groups ( < 0.01). Outcome-at-discharge as deceased correlated with higher costs, with substantial differences within groups ( < 0.01). The need for an intensive care unit was also a large driver of cost ( < 0.01). Females were prone to more expensive costs ( < 0.01). Surgical cases necessitated more financial resources ( < 0.01). (4) Conclusions: To the best of our knowledge, this is the first study on the cost of AP in Romania. Our findings showed that the drivers of increased AP costs might be older age, ICU, intra-hospital mortality, severe AP, local complications such as acute necrotic collections, biliary aetiology, and female sex. We found large heterogeneity and scarcity regarding cost-related data in the literature.
(1) 引言：急性胰腺炎（AP）仍然是医疗服务的一项全球性成本负担。我们发现与成本相关的报告存在高度异质性，且关于欧洲和亚洲人群中AP发作成本的数据稀缺。我们旨在估算我们人群中AP住院每日成本中位数（DCH）。我们的次要目标包括估算罗马尼亚的住院总成本（TCH）和AP总成本，以及评估AP的DCH中位数与病房、年龄、性别、住院时长（LoS）、重症监护病房（ICU）、结局、严重程度、形态学和病因之间的相关性。(2) 材料与方法：这项回顾性队列研究纳入了从布加勒斯特大学急诊医院电子健康记录中招募的1473例病例。所使用的统计检验包括柯尔莫哥洛夫 - 斯米尔诺夫检验、带有事后邓恩 - 邦费罗尼检验的克鲁斯卡尔 - 沃利斯检验以及双尾皮尔逊相关性检验。(3) 结果：我们发现AP的DCH中位数为203.8美元，TCH中位数为1360.5美元。罗马尼亚AP的年度总成本估计约为1900万美元。大多数患AP的男性（61.8%）大多治愈/病情改善出院（83.8%）；大多数有局部并发症（55.4%），其中大多与酒精相关（35.1%）。关于病因，胆源性AP是成本驱动因素，在所有研究组中均观察到显著统计学差异（<0.01）。形态学评估显示急性坏死性积液与高成本相关，且组间存在显著差异（<0.01）。成本也与严重程度相关，所有组间存在显著偏差（<0.01）。出院时死亡的结局与更高成本相关，组内存在实质性差异（<0.01）。对重症监护病房的需求也是成本的一个主要驱动因素（<0.01）。女性往往成本更高（<0.01）。手术病例需要更多资金（<0.01）。(4) 结论：据我们所知，这是罗马尼亚关于AP成本的第一项研究。我们的研究结果表明，AP成本增加的驱动因素可能是年龄较大、入住ICU、院内死亡率、重症AP、局部并发症如急性坏死性积液、胆源性病因以及女性性别。我们发现文献中与成本相关的数据存在很大异质性和稀缺性。
