The Burden and Cost of Post-ERCP Pancreatitis Among Commercially Insured People Undergoing ERCP

Background and Aims

Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary therapeutic procedure for pancreaticobiliary diseases. Post-ERCP pancreatitis can occur in up to 10-15% of cases; however, there are few data describing the incidence and financial burden of post-ERCP pancreatitis in a nationally representative sample in the U.S. Our study aimed to: 1) characterize the 30-day incidence of post-ERCP pancreatitis; 2) identify patient-and procedure factors associated with post-ERCP pancreatitis; and 3) describe 30-day direct and out-of-pocket (OOP) costs among patients with post-ERCP pancreatitis.

Methods

We used the Merative MarketScan commercial claims data to identify inpatient and outpatient ERCPs occurring from 2019-2021. The primary outcome was the development of post-ERCP pancreatitis within 30 days of an ERCP. The main measure of financial burden was the total direct and OOP costs of the index ERCP and all encounters within 30 days after the index ERCP. We used multivariable regression to identify factors and estimate adjusted costs of post-ERCP pancreatitis.

Results

Among 27,482 patients who underwent a total of 42,212 ERCPs during the study period, post-ERCP pancreatitis was observed in 5.7% of patients. In multivariable analysis, the highest odds of post-ERCP pancreatitis was observed among the youngest age group ≤17 years undergoing ERCP (OR 1.53, 95% CI 1.06-2.21). The 30-day adjusted mean direct costs among persons with and without post-ERCP pancreatitis were $38,569 and $30,103, respectively (difference: $8,483). The population-level cost of post-ERCP pancreatitis ranged from $85,833,757 to 432,648,810 across a range of reported estimates for post-ERCP pancreatitis and annual ERCP volume in the US.

Conclusions

Post-ERCP pancreatitis is relatively uncommon, occurring in 5-6% of individuals, but results in substantial financial burden.