Medical Professional Publications

Number of Children Hospitalized for Gastroparesis Rising Sharply, Along with Overall Costs

Columbus, OH — May 2017

The cost of hospitalizing children with gastroparesis at academic hospitals across the United States increased 580 percent in one decade, driven by an increase in admissions, physician-researchers at Nationwide Children's Hospital have found.

Electronic medical records from more than 40 institutions show costs steadily climbed from $6.2 million in 2004 to $35.7 million in 2013.

During the decade, the mean cost per gastroparesis hospitalization remained steady at about $28,000 when adjusted for inflation, but the number of children admitted for the condition grew by nearly 130 each year.

"In general, functional gastrointestinal and motility disorders are common, but what's not fully appreciated is the cost of care for those diseases," says Peter Lu, MD, an attending pediatric gastroenterologist at Nationwide Children’s, a member of the hospital’s Motility Center physician team and lead author of the gastroparesis study. "This gives us more reason to develop cost-effective tests and treatment."

The study, published in Neurogastroenterology & Motility, is a step toward understanding baseline costs for care, Dr. Lu says.

The number of unique patients hospitalized with gastroparesis increased annually from 174 to 723 over the decade, and 17 percent were hospitalized more than once, the research showed. The average initial hospitalization for boys cost about $7,000 more than for girls.  For children aged 0 to 5, the cost was more than twice as much — $61,536 — as for patients aged 16 to 21.

While academic hospitals in the southern United States accounted for 40 percent of the hospitalizations, cost for the initial in-hospital stay was the lowest there, averaging $29,752. The western United States had the highest initial cost, averaging $54,448.

Dr. Lu and colleagues looked at the related diagnoses of dyspepsia and unspecified functional disorder of the stomach, to determine if the increased admissions may be due to people diagnosing the condition differently. Adult studies have shown an increase in gastroparesis hospitalizations and a concurrent significant decrease in admissions for dyspepsia and functional disorders of the stomach.

"Among children, all three conditions were increasing," says Dr. Lu, who is also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. "That tells us the increase in gastroparesis is not likely because people are diagnosing or coding conditions differently."

In light of research that shows pediatric hospitalizations have been declining nationally during this time period, the rise in hospitalizations for these conditions "is even more striking," Dr. Lu says.

The researchers suggest a possible reason for the trend is an increasing awareness of the three conditions. Specifically for gastroparesis, the increase may be a true increase in prevalence or an increase in overall severity of the disease in children, they say.

In order to get the full picture, the researchers say they need to study the outpatient care of children with gastroparesis. That would show whether the prevalence of the disease has been constant and the increase in hospitalizations is due simply to more children being admitted.

Dr. Lu, who has been investigating the use of gastric electrical stimulation for functional GI and motility disorders, is studying whether the treatment is effective for gastroparesis and cost effective compared to traditional medications.

"In research, cost-effectiveness is often judged by comparing the cost of care to the benefit gained from the care provided," he explained. "In practice, however, this is less straightforward. . .At its most basic, I think cost-effective care begins with physicians recognizing that treatments have costs, and avoiding recommending tests and treatments that have little evidence for their use and are expensive. This study helps start that process."

Reference:
Lu PL, Moore-Clingenpeel M, Yacob D, Di Lorenzo C, Mousa MH. The rising cost of hospital care for children with gastroparesis: 2004-2013. Neurogastroenterology & Motiliy. 2016 Nov;28(11):1698-1704.

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