Regional Cost Variation for Acute Pancreatitis in the U.S.
Abstract
Context Acute pancreatitis is one of the most common causes for acute hospitalization related to digestive disease. Objectives This study aimed to examine regional variation in national healthcare expenditure for management of acute pancreatitis. Methods The Nationwide Inpatient Sample from 2010 was utilized to examine hospitalizations for acute pancreatitis. Total costs per hospitalization were calculated from charges using a cost-to-charge ratio and adjusted for suspected cost determinants from multivariable regression analysis. States were then ranked by costs and divided into tertiles for evaluation of outcome measures, including in-hospital mortality. Results Acute pancreatitis accounted for 288,597 hospitalizations in 2010. Regional variation was demonstrated after adjustment with a mean cost per hospitalization of $12,446.48. There was a difference of $4,870 per hospitalization between states in low cost and high cost tertiles. High cost states had a greater use of mechanical ventilation and infusion of supplemental nutrition (P<0.0001). Despite these differences, in-hospital mortality remained similar across cost tertiles (P=0.44). Several low-cost states were identified in traditionally high-cost regions. Conclusions Significant regional variation in costs for acute pancreatitis persisted after adjusting for patient demographics, hospital characteristics and case mix variables. This variation suggests opportunities for increasing efficiency without compromising quality of care for acute pancreatitis.
Image: Regional variation by post adjustment cost tertiles for acute pancreatitis in 2010.
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References
Healthcare Cost and Utilization Project. Updated 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/research/data/hcup/index.html. Accessed April 2014.
Hartman M, Martin AB, Benson J, et al. National health spending in 2011: overall growth remains low, but some payers and services show signs of acceleration. Health Aff (Millwood). 2013; 32: 87-99. [PMID:23297275]
Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143: 1179-1187. [PMID:22885331]
Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol. 2007; 17: 491-497. [PMID:17448682]
Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part 1: overall and upper gastrointestinal diseases. Gastroenterology. 2009; 136: 376-386. [PMID:19124023]
Cuckler G, Martin A, Whittle L, et al. Health spending by state of residence, 1991-2009. Medicare Medicaid Res Rev. 2011; 1. [PMID:22340779]
Levit KR, Lazenby HC, Cowan CA, et al. Health spending by state: new estimates for policy making. Health Aff (Millwood). 1993; 12: 7-26. [PMID:8244248]
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013; 108: 1400-1415. [PMID:23896955]
Introduction to the HCUP Nationwide Inpatient Sample. Updated 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2011.jsp. Accessed April 2014.
Cost-to-Charge Ratio Files: 2010 Nationwide Inpatient Sample User Guide. Updated 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed April 2014.
Duan N. Smearing Estimate: A Nonparametric Retransformation Method. Journal of the American Statistical Association 2012; 78: 605-610.
Lagu T, Rothberg MB, Shieh MS, et al. What is the best method for estimating the burden of severe sepsis in the United States? J Crit Care. 2012; 27: 411-414. [PMID:22516143]
Makarov DV, Loeb S, Landman AB, et al. Regional variation in total cost per radical prostatectomy in the healthcare cost and utilization project nationwide inpatient sample database. J Urol. 2010; 183: 1504-1509. [PMID:20172559]
Yin H, Radican L, Kong SX. A study of regional variation in the inpatient cost of lower extremity amputation among patients with diabetes in the United States. J Med Econ. 2013; 16: 820-827. [PMID:23675824]
Obirieze AC, Gaskin DJ, Villegas CV, et al. Regional variations in cost of trauma care in the United States: who is paying more? J Trauma Acute Care Surg. 2012; 73: 516-522. [PMID:23019681]
Murata A, Matsuda S, Mayumi T, et al. Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database. Dig Liver Dis. 2012; 44: 143-148. [PMID:21930445]
Murata A, Matsuda S, Mayumi T, et al. Effect of hospital volume on clinical outcomes in patients with acute pancreatitis, based on a national administrative database. Pancreas. 2011; 40: 1018-1023. [PMID:21926541]
Shen H, Lu C, Li C. The effect of hospital volume on patient outcomes in severe acute pancreatitis. BMC Gastroenterol. 2012; 12:112. [PMID:22901053]
Hamada T, Yasunaga H, Nakai Y, et al. Impact of hospital volume on outcomes in acute pancreatitis: a study using a nationwide administrative database. J Gastroenterol. 2014; 49: 148-155. [PMID:24113818]
Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology. 2013; 144: 1272-1281. [PMID:23622137]
Baillargeon JD, Orav J, Ramagopal V, et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998; 93: 2130-2134. [PMID:9820385]
Wall I, Badalov N, Baradarian R, et al. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas. 2011; 40(4): 547-550. [PMID:21499208]
Moon M. Health Care Spending in Maryland: How Does it Differ from Other States and Why? Silver Spring: Maryland Health Care Commission, 2010.
Massachusetts Health Care Reform: Six Years Later. Updated 2012. The Henry J. Kaiser Family Foundation. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8311.pdf. Accessed April 2014.
Saligram S, Saul M, Yadav D. Analyses of Hospital Administrative Data That Use Diagnosis Codes Overestimate the Cases of Acute Pancreatitis. Clin Gastroenterol Hepatol. 2012; 10: 805-811. [PMID:22504004]
O'Malley KJ, Cook KF, Price MD, et al. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005; 40: 1620-1639.
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