Management and cost of healthcare of acute pancreatitis – a single center experience
Introduction: Acute pancreatitis (AP) is a common cause of acute abdominal pain requiring hospital admission. In the Philippines, an extrapolated incidence of 25,300 annually was calculated. In most, acute pancreatitis is a benign and self-limiting disease that resolves within a week with conservative management. In some 20% of patients however it is often severe with high morbidity and mortality. Many reports from different countries detailing the pattern of the disease and their experience in the management have helped to define the magnitude of the problem and to evaluate the strategies for improving quality of care. However, there is a need for critical assessment of outcome measures that also include health economical aspects. The present study was designed to recognize the clinical picture of acute pancreatitis in St. Luke’s Medical Center, Quezon City and to evaluate management and cost of healthcare.
Methodology: Seventy (70) consecutive cases of acute pancreatitis admitted and treated at St. Luke’s Medical Center, Quezon City, Philippines from January to December 2014, were included. Demographic data of age, sex, and body mass index were determined. The clinical presentation, associated medical conditions, laboratory and radiological investigations, etiology, management, outcome, and healthcare cost were studied by reviewing the medical records of all cases documented to have acute pancreatitis during the period of study. Costs were calculated as total hospital costs per patient at the primary hospital stay, including expenses on the ward, ICU stay, anesthesia and operating costs, radiological and clinical physiology expenses, costs for laboratory analysis and blood products. All costs are computed using the Philippine Peso currency. Frequencies and percentages represented categorical variables. Continuous variables were demonstrated as medians with 25th and 75th percentiles. Most categorical variables were analyzed using Chi-square test except for those with smaller frequencies, where Fisher’s exact test was used. The level of significance was set at P <0.05
Results: There was a pronounced difference between severe and mild acute pancreatitis when comparing costs for the primary hospital stay, a median of Php 1,252,961.32 (448,251.05-1,451,152.70) in severe acute pancreatitis vs Php 158,002.53 (100,260.63-245,819.59) in mild acute pancreatitis and a mean of Php 1, 009,564.46 (±613,598.99) vs Php196, 873.07 (±141,591.26) (p <0.0001). The total cost of healthcare of acute pancreatitis for the year 2014 at St.Luke’s Medical Center, Quezon City is approximately Php 14,751,500.00, that is approximately Php 186,114.03 (122,592.41-392,614.56) per hospitalization regardless of severity.
Conclusion: Acute pancreatitis is a complex disease, requiring prompt diagnosis and management to prevent further complications. Initial medical management of acute pancreatitis has not yet had a paradigm shift in our current practice in the center particularly in aggressive fluid hydration, early enteral nutrition and antibiotic prophylaxis. Early surgical management of gallstone pancreatitis on index hospitalization has demonstrated benefit in terms of total hospital stay and cost of readmissions compared to waiting for an interval surgical procedure after discharge. The direct medical cost of severe acute pancreatitis management is approximately 5 times more expensive than treating a mild acute pancreatitis. The financial burden increases even in mild acute pancreatitis if readmissions and other pancreatitis-related events occur.