Gastroenterology

Gastroenterology

Volume 156, Issue 1, January 2019, Pages 254-272.e11
Gastroenterology

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

https://doi.org/10.1053/j.gastro.2018.08.063Get rights and content

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.

Section snippets

Symptoms and Diagnoses Across Ambulatory Settings

We used the 2014 National Ambulatory Medical Care Survey (NAMCS) to tabulate the leading GI symptoms and diagnoses in the United States for office-based outpatient visits. We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits for 2014. NHAMCS collects data on the utilization of ambulatory care services in hospital EDs regardless of outcome (ie, discharge from the ED, hospital admission, transfer, or death). NAMCS and NHAMCS are annual national surveys sponsored by

Symptoms and Diagnoses Across Ambulatory Settings

Using weighted national data, in 2014 there were more than 40.7 million ambulatory visits in the United States for GI symptoms (Table 1) and 54.4 million ambulatory visits with a primary diagnosis code for a GI disease (Table 2). The symptom of abdominal pain was responsible for more than 21.8 million total visits, followed by vomiting (4.7 million visits) and diarrhea (3.4 million visits) (Table 1). Abdominal pain was also the most frequent diagnosis (Table 2), with 16.5 million annual visits.

Discussion

The impact of GI diseases on patients and the health care system in the United States is substantial. Annual health care expenditures for these diseases total $135.9 billion. This is more than expenditures for heart disease ($113.4 billion), trauma-related disorders ($102.7 billion), and mental disorders ($98.8 billion).12 There are more than 40.7 million ambulatory visits for GI symptoms and 54.4 million visits with a primary diagnosis for a GI disease each year. There are more than 3.0

Acknowledgments

Author contributions: AFP, SDC, CCM, JLL, ESD, JLW, ETJ, NJS, ASB, SRL, BK, ELB, YCF, VP, JG, THB, RSS: data collection, data analysis, conception and study design, interpretation of data, manuscript preparation.

References (45)

  • R.J. Huang et al.

    Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013

    Gastrointest Endosc

    (2017)
  • L.C. Seeff et al.

    How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity

    Gastroenterology

    (2004)
  • S.D. Dorn et al.

    Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured

    Clin Gastroenterol Hepatol

    (2012)
  • D.K. Rex

    Polyp detection at colonoscopy: Endoscopist and technical factors

    Best Pract Res Clin Gastroenterol

    (2017)
  • A. Mehrotra et al.

    Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures

    Gastrointest Endosc

    (2012)
  • L. Wang et al.

    Low rates of gastrointestinal and non-gastrointestinal complications for screening or surveillance colonoscopies in a population-based study

    Gastroenterology

    (2018)
  • M.F. Kaminski et al.

    Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death

    Gastroenterology

    (2017)
  • D.A. Lieberman et al.

    Race, ethnicity, and sex affect risk for polyps >9 mm in average-risk individuals

    Gastroenterology

    (2014)
  • R.B. Mendelsohn et al.

    Adenoma prevalence in blacks and whites having equal adherence to screening colonoscopy: the National Colonoscopy Study

    Clin Gastroenterol Hepatol

    (2017)
  • D.A. Corley et al.

    Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs

    Clin Gastroenterol Hepatol

    (2013)
  • P.A. Myer et al.

    Clinical and economic burden of emergency department visits due to gastrointestinal diseases in the United States

    Am J Gastroenterol

    (2013)
  • G.L. Armstrong et al.

    The prevalence of hepatitis C virus infection in the United States, 1999 through 2002

    Ann Intern Med

    (2006)
  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

    Funding This research was supported in part by grants from the National Institutes of Health, K23DK113225, KL2TR001109, KL2TR001103, and T32 DK07634.

    View full text