title: Patient satisfaction and cost-effectiveness following total pancreatectomy with islet cell transplantation for chronic pancreatitis.
abstract: OBJECTIVE
  Chronic pancreatitis (CP) results in an extremely poor quality of life and substantially increases health care utilization. Few data exist regarding the cost-effectiveness of surgical treatment for CP.
  
  
  METHODS
  This article examined the cost-effectiveness of total pancreatectomy (TP) with islet cell autotransplantation (IAT) for CP.
  
  
  RESULTS
  Sixty patients undergoing TP + IAT and 37 patients undergoing TP were identified. Surgery resulted in significant reduction in opiate use, frequency of hospital admissions, and length of stay as well as visual analog scale scores for pain. Total pancreatectomy + IAT resulted in longer survival than TP alone (16.6 vs 12.9 years); 21.6% of patients with TP + IAT were insulin-independent, and those requiring insulin have reduced daily requirements compared with those having TP alone (22 vs 35 IU). The cost of TP + IAT with attendant admission and analgesia costs over the 16-year survival period was £110,445 compared with £101,608 estimated 16-year costs if no TP + IAT was undertaken.
  
  
  CONCLUSIONS
  Total pancreatectomy + IAT is effective in improving pain and reducing analgesia. Islet cell transplantation offers the chance of insulin independence and results in lower insulin requirements, as well as conferring a survival advantage when compared with TP alone. Total pancreatectomy + IAT is cost-neutral when compared with nonsurgical or segmental surgical therapy.
authors: Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, United Kingdom. gg43@le.ac.uk
authors: Giuseppe
authors: G
authors: Garcea
authors: Cristina A
authors: CA
authors: Pollard
authors: Severine
authors: S
authors: Illouz
authors: M'Balu
authors: M
authors: Webb
authors: Matthew S
authors: MS
authors: Metcalfe
authors: Ashley R
authors: AR
authors: Dennison
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004651:Employment / Q000191:economics; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D010149:Postoperative Pain / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D050500:Pancreatitis, Chronic / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D010359:Patient Readmission / Q000191:economics; D017060:Patient Satisfaction; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D007004:Hypoglycemic Agents; D007328:Insulin