OBJECTIVES:

Pancreatitis is the most common complication associated with endoscopic retrograde cholangiopancreatography (ERCP) procedures. This analysis estimated the economic burden of post-ERCP pancreatitis in the inpatient setting among elderly Medicare beneficiaries.

METHODS:

We identified individuals who underwent inpatient ERCP from 100% Medicare Standard Analytic Files between January 1, 2016 and March 31, 2022, with the index date considered the first observed ERCP procedure. The study period for each individual covers 6 months pre-index through the end of the post-index 6 months (post-period). We excluded individuals who were below the age of 65 years, were not continuously enrolled during their study period, or had a prior diagnosis of pancreatitis. We measured time from the index date to the first diagnosis date of pancreatitis following the index ERCP to calculate an incidence rate of post-ERCP pancreatitis. We estimated medical costs for the index ERCP procedure and post-period, as well as length of stay (LOS) during the index ERCP procedure.

RESULTS:

Among 186,618 inpatient ERCP patients identified (47% men, mean age of 77 years), 51,263 had post-ERCP pancreatitis (27.47%) and 135,355 did not. Of those 51,263 patients, 47,443 (93%) developed pancreatitis on the index date of the procedure, with an estimated post-ERCP pancreatitis incidence rate of 19.8 per 100 person-days. When comparing patients with post-ERCP pancreatitis versus those without – mean (median) LOS were 7 (5) versus 6 (4) days, mean medical costs per person during index hospitalization were $17,617 versus $15,182, and mean medical costs per person during the post-period were $34,312 versus $32,654, respectively (for all three mean comparisons, p<.0001 from Wilcoxon rank-sum tests).

CONCLUSIONS: Individuals who developed post-ERCP pancreatitis had higher costs and longer LOS. Future studies are warranted to extend this analysis to include outpatient settings and the privately-insured adult population.