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High burden, costs associated with recurrent acute, chronic pancreatitis in children
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Recurrent acute and chronic pancreatitis in children are associated with high disease burden and health care costs related to repeat hospitalizations, according to two studies recently published in the Journal of Pediatric Gastroenterology and Nutrition.
“One study finds a 42% rate of rehospitalizations in children after an initial pancreatitis attack, while the other study estimates annual health care costs of about $40,000 for children with recurrent acute or chronic pancreatitis,” according to a press release.
Pediatric Health Information System cohort
In the first study, researchers used the Pediatric Health Information System — a large national, multicenter health care database — to identify 26,435 children aged 1 to 17 years (median age, 12 years) who were diagnosed with acute pancreatitis and were hospitalized from 2002 through 2014. Among them, 10,648 were index hospitalizations for acute pancreatitis, 42% of whom underwent a total of 15,787 rehospitalizations (median, two hospitalizations per patient; median time between admissions, 86 days).
The overall mortality rate (0.4%) was significantly lower than those shown by prior pediatric studies (5% to 11%), but the 42% rehospitalization rate was significantly higher.
Compared with those who had a single episode of acute pancreatitis, patients with acute recurrent pancreatitis were younger (median age, 11 vs. 13 years), had a more severe index episode of acute pancreatitis as demonstrated by a longer length of stay (median, 5 vs. 4 days), had higher hospital charges (median, $26,000 vs. $17,000), and were more likely to require ICU care (RR = 2.1; 95% CI, 1.8-2.4; all P < .01).
INSPPIRE registry cohort
In the second study, researchers performed a cross-sectional study of hospital-related costs among 224 children (median age, 12.7 years) with chronic pancreatitis (42%) and acute recurrent pancreatitis who were enrolled in the multinational INSPPIRE registry between August 2012 and March 2014.
On average, there were 2.3 hospitalizations per person per year (including those for surgery and endoscopic retrograde cholangiopancreatography [ERCP]), corresponding to an estimated mean cost per person per year of $38,755 ($40,589 when including outpatient medications).
Estimated mean costs for surgeries per person per year was $42,951 among patients who underwent surgery, and costs of ERCP was $12,035 among patients who underwent the procedure.
Estimated costs per year per patient were $4,114 for pancreatic enzyme replacement therapy, $1,761 for diabetic medications, $614 for pain medications and $91 for corticosteroids.
Costs were at least 50% higher for patients who had at least four acute recurrent pancreatitis or chronic pancreatitis attacks per year, those who reported constant or episodic pain, those with a family history of pancreatic cancer and those who use pain medication.
“By extrapolating these costs from the INSPPIRE registry, pediatric [chronic pancreatitis] alone may result in an estimated $64 million cost to the U.S. health care system per year,” the researchers wrote. “Studies that improve our knowledge of these disorders and enhance our outpatient pain management strategies may reduce the need for hospitalizations, lower health care costs and improve quality of life of these children and their families.”
A bigger problem than previously thought
According to a related editorial by William E. Bennett, Jr., MD, Indiana University School of Medicine, these studies “suggest that the problem may be bigger (at least financially) than previously thought.” Both studies “reached a similar conclusion: recurrent pancreatitis is expensive because patients with recurrent pancreatitis use more services.”
Bennett “suggests establishing a nationwide registry of pancreatitis in children, enrolling more children in studies of pancreatitis treatment, and increasing research to understand the unique features of chronic pancreatitis in children — including genetic causes,” according to a press release. – by Adam Leitenberger
Disclosures: One researcher reports she is a consultant for AbbVie for exocrine pancreatic function testing. Please see the studies for full lists of all other researchers’ relevant financial disclosures.
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