Cost-Effectiveness of Total Pancreatectomy and Islet Cell Autotransplantation for the Treatment of Minimal Change Chronic Pancreatitis

Introduction The current standard of care for the management of minimal change chronic pancreatitis (MCCP) is medical management. Controversy exists, however, regarding the use of surgical intervention for MCCP. We hypothesized that total pancreatectomy and islet cell autotransplantation (TPIAT) decreases long-term resource utilization and improves quality of life, justifying initial costs and risks. Methods Detailed perioperative outcomes from 46 patients with MCCP populated a Markov model comparing medical management to TPIAT. Mortality, complications, readmission rates, insulin and narcotic use, imaging, and endoscopy were included in the model. Outcomes reported were survival, measured in quality-adjusted life years (QALYs), and costs, in 2013 US dollars. Results In medical patients, annual mean hospital admissions were 1.6 (range=0-11), endoscopy 1.4 (0-6), and imaging (CT/MRI) 1.5 (0-4). In surgical patients, there were no perioperative deaths, with complication and 30-day readmission rates of 47 and 37%. One year after TPIAT, annualmean admissions, endoscopy, and imaging had decreased to 0.9 (0-4), 0.4 (0-2), and 0.9 (0-5); monthly narcotic use decreased from 138 to 37 morphine equivalents (p=0.012). Cost and survival for TPIAT versus medical management were $ 153,575/14.9 QALYs and $ 196,042/11.5 QALYs, respectively. Conclusions In patients with MCCP, TPIAT is associated with decreased cost and increased quality-adjusted survival. Providers and insurers should more enthusiastically embrace TPIAT use as a more effective cost-saving strategy.