[Cost effectiveness study on the use of somatostatin for reduction of acute pancreatitis after ERCP].
OBJECTIVE
Recent studies show that intravenous injection of somatostatin before endoscopic retrograde cholangiopancreatography (ERCP) is associated with a significant reduction in the rate of post-ERCP acute pancreatitis. The lack of data in our environment led us to study the possible economic benefits of somatostatin administration, obtained through the reduction of costs due to post-ERCP acute pancreatitis.


METHODS
Theoretical study of the direct costs of post-ERCP acute pancreatitis using Markov's tree decisions. The costs of the group pre-treated with intravenous administration of 3 mg of somatostatin were compared with those of the control group. Post-ERCP rates of pancreatitis of 10% were accepted in the control group and rates of 3% were accepted in the somatostatin group. The costs of the different types of pancreatitis were as follows: costs with and without complications and with surgical intervention were based on the diagnosis related group-weights applied by the Ministry of Health in the Contract-program of the Health Service of Navarre for 1999. A sensitivity analysis was carried out to determine the rate of post-ERCP pancreatitis from which an economic benefit would be obtained in the group pre-treated with somatostatin.


RESULTS
Mean theoretical cost per procedure was 121,640 pesetas for the control group and 105,539 for the group pre-treated with somatostatin. Saving per patient was 13.26% (16,101 pesetas). The sensitivity analysis revealed that in the control group premedication produced an economic benefit starting from a pancreatitis rate of 4.2%.


CONCLUSIONS
Independently of the clinical benefit signifying the reduction of post-ERCP pancreatitis, somatostatin administration led to a saving of 16,101 pesetas per patient. Accepting that the pancreatitis rate in the treated group was proportionately reduced, the sensitivity analysis showed that premedication produced an economic benefit starting from a pancreatitis rate of 4.2% in the control group.
Borda
F
F
Servicio de Digestivo. Hospital de Navarra. Pamplona.
Jiménez
F J
FJ
Vila
J
J
Carral
D
D
Zozaya
J M
JM
Pastor
G
G
Aznarez
R
R
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003362:Cost-Benefit Analysis; D006728:Hormones / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D010195:Pancreatitis / Q000188:drug therapy* / Q000601:surgery; D011182:Postoperative Care; D013004:Somatostatin / Q000191:economics* / Q000627:therapeutic use*
D006728:Hormones; D013004:Somatostatin