title: Prospective assessment of out-of-pocket patient-related cost for ERCP at an urban tertiary care medical center.
abstract: BACKGROUND
  When calculating differences between interventions, direct cost comparisons are typically based on Medicare reimbursement rates. The additional out-of-pocket costs of the patient have been little studied in endoscopy.
  
  
  OBJECTIVE
  To determine out-of-pocket costs for patients undergoing ERCP.
  
  
  METHODS
  Between June and August 2009, all outpatients referred to our tertiary care university hospital for elective ERCP were prospectively interviewed regarding out-of-pocket costs for procedures. Patients were asked regarding any costs to undergo the procedure including co-pay, driving, parking, meals, child care or equivalent, and any additional expenses related to subsequent procedures or admissions related to the ERCP.
  
  
  RESULTS
  Over the study period, 94 outpatients (mean age 57 ± 16 years, 48% male) underwent ERCP. Mean/median out-of-pocket costs for the procedure were $177.97/72.54 and ranged from $0 to $2,033.54. The largest single expense for the procedure was related to copayment (median $75). Eleven patients required hospitalization for post-procedural complications resulting in additional median out-of-pocket costs of $25. Median hotel, food, and travel expenses were $171.00, $20.00, and $23.54, respectively.
  
  
  CONCLUSIONS
  Out-of-pocket ERCP costs are not insignificant from the patient's perspective and should be added to the direct costs to calculate true procedure costs.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0001, USA. melw@uab.edu
authors.forename: C
authors.initials: C
authors.lastname: Mel Wilcox
authors.forename: Roshan
authors.initials: R
authors.lastname: Patel
authors.forename: Chad
authors.initials: C
authors.lastname: Burski
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
mesh_terms: D000328:Adult; D000368:Aged; D000407:Alabama; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D020380:Needs Assessment / Q000191:economics*; D011446:Prospective Studies; D014481:United States; D019037:Urban Health Services / Q000191:economics*