title: Effect and cost of treatment for acute pancreatitis with or without gabexate mesylate: a propensity score analysis using a nationwide administrative database.
abstract: OBJECTIVE
  Despite a lack of evidence, gabexate mesylate (GM) is routinely used for the treatment of acute pancreatitis (AP) in some countries. The present study examined the effect and cost of GM for AP treatment using the Japanese Diagnosis Procedure Combination database.
  
  
  METHODS
  We performed a propensity score analysis to compare inhospital mortality, length of stay (LOS), and total costs between patients with AP treated with GM and those without GM in 2010.
  
  
  RESULTS
  We identified 2483 patients treated with GM and 890 patients without GM. Overall, 77% of the patients treated with GM were nonsevere AP cases. The propensity-matched 707 pairs showed no significant difference between GM users and nonusers in inhospital mortality or median length of stay in nonsevere AP (1.0% vs 1.2%, P = 0.789; 10 vs 10 days, P = 0.160) and severe AP (8.4% vs 5.0%, P = 0.438; 12 vs 14 days, P = 0.487) cases. Total costs were significantly different between the GM users and the nonusers in nonsevere AP cases (US$4982 vs US$4373, P < 0.001), but not in severe AP cases ($6605 vs $6490, P = 0.764).
  
  
  CONCLUSIONS
  Using GM for nonsevere AP cannot be justified because of higher costs without significant effects. Gabexate mesylate use is also not justifiable for severe AP because it does not reduce mortality or length of stay.
authors.affiliation: Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. yasunagah-tky@umin.ac.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D016670:Gabexate / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D057216:Propensity Score; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015842:Serine Proteinase Inhibitors; D016670:Gabexate