Tavakkoli Anna, Kapinos Kandice A, Elmunzer B Joseph, Kwon Richard S, Troendle David M, Zhang Song, Singal Amit G
Division of Digestive & Liver Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
RAND Corporation, Arlington, Virginia, USA.
Gastrointest Endosc. 2025 Mar 20. doi: 10.1016/j.gie.2025.03.639.
ERCP is the primary therapeutic procedure for pancreaticobiliary diseases. Post-ERCP pancreatitis can occur in up to 10% to 15% of cases; however, very little data describe the incidence and financial burden of post-ERCP pancreatitis in a nationally representative sample in the United States. In this study, we characterized the 30-day incidence of post-ERCP pancreatitis, identified patient- and procedure-related factors associated with post-ERCP pancreatitis, and described 30-day direct and out-of-pocket (OOP) costs among patients with post-ERCP pancreatitis.
We used the Merative MarketScan commercial claims data to identify inpatient and outpatient ERCPs occurring from 2019 to 2021. The primary outcome was the development of post-ERCP pancreatitis within 30 days of an ERCP. The main measure of financial burden was the total direct and OOP costs of the index ERCP and all encounters within 30 days after the index ERCP. We used multivariable regression to identify factors and estimate adjusted costs of post-ERCP pancreatitis.
Among 27,482 patients who underwent 42,212 ERCPs during the study period, post-ERCP pancreatitis was observed in 5.7% of patients. In multivariable analysis, the highest odds of post-ERCP pancreatitis was observed among the youngest age group (≤17 years) undergoing ERCP (odds ratio, 1.53; 95% CI, 1.06-2.21). The 30-day adjusted mean direct costs among persons with and without post-ERCP pancreatitis were $38,569 and $30,103, respectively (difference, $8483). The population-level cost of post-ERCP pancreatitis ranged from $85,833,757 to $432,648,810 across a range of reported estimates for post-ERCP pancreatitis and annual ERCP volume in the United States.
Post-ERCP pancreatitis is relatively uncommon, occurring in 5% to 6% of individuals, but results in substantial financial burden.
内镜逆行胰胆管造影术（ERCP）是治疗胰胆疾病的主要方法。ERCP术后胰腺炎的发生率可达10%至15%；然而，在美国具有全国代表性的样本中，关于ERCP术后胰腺炎的发生率和经济负担的数据却非常少。在本研究中，我们对ERCP术后胰腺炎的30天发生率进行了特征描述，确定了与ERCP术后胰腺炎相关的患者和手术相关因素，并描述了ERCP术后胰腺炎患者的30天直接成本和自付费用。
我们使用了默克多市场扫描商业索赔数据来识别2019年至2021年期间发生的住院和门诊ERCP手术。主要结局是ERCP术后30天内发生ERCP术后胰腺炎。经济负担的主要衡量指标是首次ERCP手术的直接成本和自付费用以及首次ERCP手术后30天内的所有诊疗费用。我们使用多变量回归来确定相关因素并估计ERCP术后胰腺炎的调整成本。
在研究期间接受42,212例ERCP手术的27,482例患者中，5.7%的患者发生了ERCP术后胰腺炎。在多变量分析中，接受ERCP手术的最年轻年龄组（≤17岁）发生ERCP术后胰腺炎的几率最高（优势比，1.53；95%可信区间，1.06 - 2.21）。有和没有ERCP术后胰腺炎的患者30天调整后平均直接成本分别为38,569美元和30,103美元（差值为8483美元）。根据美国报道的一系列ERCP术后胰腺炎估计发生率和年度ERCP手术量，ERCP术后胰腺炎的总体成本在85,833,757美元至432,648,810美元之间。
ERCP术后胰腺炎相对不常见，发生率为5%至6%，但会导致巨大的经济负担。
