William Baumgartner, MD1, Jason R. Stibbe, MD, MS1, Daniel Raines, MD, FACG1, Wei Jiang2
1Louisiana State University Health Sciences Center, New Orleans, LA; 2Medtronic, Boston, MA
Introduction: Angioectasias are dilated, thin-walled blood vessels resulting from degenerative changes in capillary vascular structure.They can occur anywhere within the gastrointestinal tract and are the most common source of small intestinal bleeding in patients over age 50. Small bowel angioectasias have the highest re-bleeding rates when compared to other sources.It is assumed that angioectasias complicated by bleeding result in consumption of a large volume of medical resources but this consumption has not yet be quantified in the medical literature.
Methods: A retrospective cross-sectional study was performed using Medicare data base analysis of ICD-10-DM codes for patients diagnosed with anemia and/or gastrointestinal hemorrhage during 2016 and 2017. A Crosswalk analysis of ICD-10-DM codes pertaining to primary gastrointestinal bleeding and primary anemia from angioectasias converted these codes into corresponding DRG (inpatient) and CPT (outpatient) codes. These codes of interest were followed throughout 2016 and 2017 in order to determine the cost of medical care for symptomatic angioectasias.
Results: In 2016, 38,250 Medicare services were provided in the management of angioectasias at a total cost of roughly $240 million. Hospitalizations accounted for 48% of total service volume but 95% of total costs at an average expense of $12,391 per inpatient stay. Outpatient services accounted for 52% of all services provided but only 5% of total annual costs in this analysis. Average costs for individual outpatient services were broken down into categories of therapeutic endoscopy ($922), diagnostic endoscopy ($805), injections ($522), blood transfusions ($261), and outpatient clinic visits ($261). Therapeutic endoscopy was the most expensive outpatient service category, accounting for 64% of all outpatient costs. A separate analysis of 2017 Medicare data validated our findings from the previous year with a steady total cost and only slightly (5%) increase in volume of individual services.
Discussion: Angioectasias are a common source of gastrointestinal bleeding and are associated with high recurrence rates as well as substantial morbidity. This study confirms that a large volume of medical resources are consumed in that management of bleeding angioectasias. In recognition of these findings, additional research is justified to improve upon our understanding and management of this disease process.
Citation: William Baumgartner, MD; Jason R. Stibbe, MD, MS; Daniel Raines, MD, FACG; Wei Jiang. P2222 - ECONOMIC BURDEN OF BLEEDING GASTROINTESTINAL ANGIOECTASIAS. Program No. P2222. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.