title: Scoring System for the Management of Acute Gallstone Pancreatitis: Cost Analysis of a Prospective Study.
abstract: Predicting the presence of a persistent common bile duct (CBD) stone is a difficult and expensive task. The aim of this study is to determine if a previously described protocol-based scoring system is a cost-effective strategy. The protocol includes all patients with gallstone pancreatitis and stratifies them based on laboratory values and imaging to high, medium, and low likelihood of persistent stones. The patient's stratification then dictates the next course of management. A decision analytic model was developed to compare the costs for patients who followed the protocol versus those that did not. Clinical data model inputs were obtained from a prospective study conducted at The Mount Sinai Medical Center to validate the protocol from Oct 2009 to May 2013. The study included all patients presenting with gallstone pancreatitis regardless of disease severity. Seventy-three patients followed the proposed protocol and 32 did not. The protocol group cost an average of $14,962/patient and the non-protocol group cost $17,138/patient for procedural costs. Mean length of stay for protocol and non-protocol patients was 5.6 and 7.7 days, respectively. The proposed protocol is a cost-effective way to determine the course for patients with gallstone pancreatitis, reducing total procedural costs over 12 %.
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jake G
authors.initials: JG
authors.lastname: Prigoff
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Swain
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. celia.divino@mountsinai.org.|Division of General Surgery, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1259, 5th floor, New York, NY, 10029, USA. celia.divino@mountsinai.org.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies
keywords: Biliary pancreatitis; ERCP; Gallstone pancreatitis; Laparoscopic cholecystectomy; MRCP