Workplace Productivity Loss and Indirect Costs Associated With Preterm Birth in the United States

Burden and cost of post-endoscopic retrograde cholangiopancreatography pancreatitis among commercially insured people undergoing endoscopic retrograde cholangiopancreatography

BACKGROUND AND AIMS

ERCP is the primary therapeutic procedure for pancreaticobiliary diseases. Post-ERCP pancreatitis can occur in up to 10% to 15% of cases; however, very little data describe the incidence and financial burden of post-ERCP pancreatitis in a nationally representative sample in the United States. In this study, we characterized the 30-day incidence of post-ERCP pancreatitis, identified patient- and procedure-related factors associated with post-ERCP pancreatitis, and described 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 to 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 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 (odds ratio, 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, $8483). 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 United States.

CONCLUSIONS

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

Health Service Use and Costs During Pregnancy Among Privately Insured Individuals With Congenital Heart Disease

Importance

Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo recommended cardiac evaluations. Data to better understand resource allocation and financial planning are lacking.

Objective

To examine health care use and costs for patients with CHD during pregnancy.

Design, Setting, and Participants

This retrospective cohort study was performed from January 1, 2010, to December 31, 2016, using Merative MarketScan commercial insurance data. Participants included patients with CHD and those without CHD matched 1:1 by age, sex, and insurance enrollment year. Pregnancy claims were identified for all participants. Data were analyzed from September 2022 to March 2024.

Exposures

Baseline characteristics (age, US region, delivery year, insurance type) and pregnancy-related events (obstetric, cardiac, and noncardiac conditions; birth outcomes; and cesarean delivery).

Main Outcomes and Measures

Health service use (outpatient physician, nonphysician, emergency department, prescription drugs, and admissions) and costs (total and out-of-pocket costs adjusted for inflation to represent 2024 US dollars).

Results

A total of 11 703 pregnancies (mean [SD] maternal age, 31.5 [5.4] years) were studied, with 2267 pregnancies in 1785 patients with CHD (492 pregnancies in patients with severe CHD and 1775 in patients with nonsevere CHD) and 9436 pregnancies in 7720 patients without CHD. Compared with patients without CHD, pregnancies in patients with CHD were associated with significantly higher health care use (standardized mean difference [SMD] range, 0.16-1.46) and cost (SMD range, 0.14-0.55) except for out-of-pocket inpatient and ED costs. After adjustment for covariates, having CHD was independently associated with higher total (adjusted cost ratio, 1.70; 95% CI, 1.57-1.84) and out-of-pocket (adjusted cost ratio, 1.40; 95% CI, 1.22-1.58) costs. The adjusted mean total costs per pregnancy were $15 971 (95% CI, $15 480-$16 461) for patients without CHD, $24 290 (95% CI, $22 773-$25 806) for patients with any CHD, $26 308 (95% CI, $22 788-$29 828) for patients with severe CHD, and $23 750 (95% CI, $22 110-$25 390) for patients with nonsevere CHD. Patients with vs without CHD incurred $8319 and $700 higher total and out-of-pocket costs per pregnancy, respectively.

Conclusions and Relevance

This study provides novel, clinically relevant estimates for the cardio-obstetric team, patients with CHD, payers, and policymakers regarding health care and financial planning. These estimates can be used to carefully plan for and advocate for the comprehensive resources needed to care for patients with CHD.