Scoring System for the Management of Acute Gallstone Pancreatitis: Cost Analysis of a Prospective Study

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2016 Mar 23

PMID 27000127

Authors

Jake G Prigoff

Gary W Swain

Celia M Divino

Affiliations

Soon will be listed here.

Abstract

Predicting the presence of a persistent common bile duct (CBD) stone is a difficult and expensive task. The aim of this study is to determine if a previously described protocol-based scoring system is a cost-effective strategy. The protocol includes all patients with gallstone pancreatitis and stratifies them based on laboratory values and imaging to high, medium, and low likelihood of persistent stones. The patient's stratification then dictates the next course of management. A decision analytic model was developed to compare the costs for patients who followed the protocol versus those that did not. Clinical data model inputs were obtained from a prospective study conducted at The Mount Sinai Medical Center to validate the protocol from Oct 2009 to May 2013. The study included all patients presenting with gallstone pancreatitis regardless of disease severity. Seventy-three patients followed the proposed protocol and 32 did not. The protocol group cost an average of $14,962/patient and the non-protocol group cost $17,138/patient for procedural costs. Mean length of stay for protocol and non-protocol patients was 5.6 and 7.7 days, respectively. The proposed protocol is a cost-effective way to determine the course for patients with gallstone pancreatitis, reducing total procedural costs over 12 %.

References

Arguedas M, DuPont A, Wilcox C . Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model. Am J Gastroenterol. 2001; 96(10):2892-9. DOI: 10.1111/j.1572-0241.2001.04244.x. View

Makary M, Duncan M, Harmon J, Freeswick P, Bender J, Bohlman M . The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann Surg. 2004; 241(1):119-24. PMC: 1356854. DOI: 10.1097/01.sla.0000149509.77666.94. View

Chang L, Lo S, Stabile B, Lewis R, de Virgilio C . Gallstone pancreatitis: a prospective study on the incidence of cholangitis and clinical predictors of retained common bile duct stones. Am J Gastroenterol. 1998; 93(4):527-31. DOI: 10.1111/j.1572-0241.1998.159_b.x. View

Frossard J, Steer M, Pastor C . Acute pancreatitis. Lancet. 2008; 371(9607):143-52. DOI: 10.1016/S0140-6736(08)60107-5. View

Corfield A, Cooper M, Williamson R . Acute pancreatitis: a lethal disease of increasing incidence. Gut. 1985; 26(7):724-9. PMC: 1432998. DOI: 10.1136/gut.26.7.724. View

Urbach D, Khajanchee Y, Jobe B, Standage B, Hansen P, Swanstrom L . Cost-effective management of common bile duct stones: a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography, and laparoscopic bile duct exploration. Surg Endosc. 2001; 15(1):4-13. DOI: 10.1007/s004640000322. View

Brown L, Rogers S, Cello J, Brasel K, Inadomi J . Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones. J Am Coll Surg. 2011; 212(6):1049-1060.e1-7. PMC: 3163150. DOI: 10.1016/j.jamcollsurg.2011.02.017. View

Rhodes M, SUSSMAN L, Cohen L, Lewis M . Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998; 351(9097):159-61. DOI: 10.1016/s0140-6736(97)09175-7. View

van Santvoort H, Bakker O, Besselink M, Bollen T, Fischer K, Nieuwenhuijs V . Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis. Endoscopy. 2010; 43(1):8-13. DOI: 10.1055/s-0030-1255866. View

10.

Cheng C, Sherman S, Watkins J, Barnett J, Freeman M, Geenen J . Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006; 101(1):139-47. DOI: 10.1111/j.1572-0241.2006.00380.x. View

11.

Sherman J, Shi E, Ranasinghe N, Sivasankaran M, Prigoff J, Divino C . Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis. Surgery. 2015; 157(6):1073-9. DOI: 10.1016/j.surg.2015.01.005. View

12.

Cohen M, Slezak L, Wells C, Andersen D, Topazian M . Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends. Am J Gastroenterol. 2002; 96(12):3305-11. DOI: 10.1111/j.1572-0241.2001.05330.x. View

13.

Tabone L, Conlon M, Fernando E, Yi S, Sarker S, Fisichella P . A practical cost-effective management strategy for gallstone pancreatitis. Am J Surg. 2013; 206(4):472-7. DOI: 10.1016/j.amjsurg.2012.12.009. View

14.

Forsmark C, Baillie J . AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007; 132(5):2022-44. DOI: 10.1053/j.gastro.2007.03.065. View

15.

Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano M, Spirito F . Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007; 102(8):1781-8. DOI: 10.1111/j.1572-0241.2007.01279.x. View

16.

Videhult P, Sandblom G, Rasmussen I . How reliable is intraoperative cholangiography as a method for detecting common bile duct stones? : A prospective population-based study on 1171 patients. Surg Endosc. 2008; 23(2):304-12. DOI: 10.1007/s00464-008-9883-2. View

17.

Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M . Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001; 96(2):417-23. DOI: 10.1111/j.1572-0241.2001.03594.x. View

18.

Epelboym I, Winner M, Allendorf J . MRCP is not a cost-effective strategy in the management of silent common bile duct stones. J Gastrointest Surg. 2013; 17(5):863-71. DOI: 10.1007/s11605-013-2179-4. View

19.

Rogers S, Cello J, Horn J, Siperstein A, Schecter W, Campbell A . Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg. 2010; 145(1):28-33. DOI: 10.1001/archsurg.2009.226. View

20.

Talwalkar J, Angulo P, Johnson C, Petersen B, Lindor K . Cost-minimization analysis of MRC versus ERCP for the diagnosis of primary sclerosing cholangitis. Hepatology. 2004; 40(1):39-45. DOI: 10.1002/hep.20287. View