Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018

Abstract

Background & aims: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States.

Methods: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases.

Results: In 2015, annual health care expenditures for gastrointestinal diseases totaled $135.9 billion. Hepatitis ($23.3 billion), esophageal disorders ($18.1 billion), biliary tract disease ($10.3 billion), abdominal pain ($10.2 billion), and inflammatory bowel disease ($7.2 billion) were the most expensive. Yearly, there were more than 54.4 million ambulatory visits with a primary diagnosis for a GI disease, 3.0 million hospital admissions, and 540,500 all-cause 30-day readmissions. There were 266,600 new cases of GI cancers diagnosed and 144,300 cancer deaths. Each year, there were 97,700 deaths from non-malignant GI diseases. An estimated 11.0 million colonoscopies, 6.1 million upper endoscopies, 313,000 flexible sigmoidoscopies, 178,400 upper endoscopic ultrasound examinations, and 169,500 endoscopic retrograde cholangiopancreatography procedures were performed annually. Among average-risk persons aged 50-75 years who underwent colonoscopy, 34.6% had 1 or more adenomatous polyps, 4.7% had 1 or more advanced adenomatous polyps, and 5.7% had 1 or more serrated polyps removed.

Conclusions: GI diseases contribute substantially to health care use in the United States. Total expenditures for GI diseases are $135.9 billion annually-greater than for other common diseases. Expenditures are likely to continue increasing.

Keywords: Digestive System Diseases; Endoscopy; Health Care Costs; Neoplasms.

Figure 1A.

Temporal trend in hospitalizations with a principal diagnosis of chronic hepatitis C virus infection, National Inpatient Sample, 1993–2014. (B) Temporal trends in hospitalizations with any diagnosis or principal diagnosis of clostridium difficile infection, National Inpatient Sample, 1993–2014. (C) Temporal trend in hospitalizations with principal diagnosis of intestinal obstruction, National Inpatient Sample, 1993–2014.

Figure 2.

Temporal trends in emergency department visits, hospitalizations and surgeries for appendicitis, Nationwide Emergency Department Sample and National Inpatient Sample, 2006–2014

Figure 3A.

Age-adjusted incidence (2000 U.S. standard population) of colorectal cancer by 10-year age group, United States Cancer Statistics, 2000 – 2014. (B) Age-adjusted mortality (2000 U.S. standard population) of colorectal cancer by 10-year age group, United States Cancer Statistics, 2000 – 2014.

Figure 4A.

Colonoscopies performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013. (B) Upper endoscopies performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013. (C) Flexible sigmoidoscopies performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013. (D) Endoscopic retrograde cholangiopancreatographies performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013. (E) Upper endoscopic ultrasound performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013. (F) Lower endoscopic ultrasound performed per 1,000 enrollee-years, by age group, MarketScan Commercial Claims and Encounters and Medicare, 2002–2013

Figure 5A.

Adenomatous polyps on colonoscopy in screening only, ages 45–75, average risk persons by age, sex and race. (B) Advanced adenomatous polyps (≥ 10 mm, high grade dysplasia, villous component) on colonoscopy in screening only, ages 45–75, average risk persons by age, sex and race (C) Serrated polyps on colonoscopy in screening only, ages 45–75, average risk persons by age, sex and race (D) Adenocarcinoma on colonoscopy in screening only, ages 50–75, average risk persons by age, sex and race