A financial audit of total pancreatectomy and islet-auto transplantation with remote isolation compared with traditional medical management and the expected complications of hereditary pancreatitis: a South Australian perspective
Alice Rickard1, Colleen Etherton1, Tiah Doody1, Anita Yu1, Sadia Jahan1, Nicholas O'Kane1, Alex Silverwood7, Chris Drogemuller1, Denghao Wu6, Mikhail Boiarski7, Kay Tom5, Loudovaris Tom5, Coates Toby1, Couper Richard3, Sanjeev Khurana2, Chen John4.
1Central Northern Adelaide Renal Transplant Service, Royal Adelaide Hospital, Adelaide, Australia; 2Paediatric Surgery, Women's and Children's Hospital, Adelaide, Australia; 3Gastroenterology , Women's and Children's Hospital, Adelaide, Australia; 4Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia; 5Islet Isolation, St Vincent's Institute for Medical Research, Melbourne, Australia; 6Faculty of Science, Engineering and Technology, University of Adelaide, Adelaide, Australia; 7Central Adelaide Local Health Network, SA Health, Adelaide, Australia
The Australian Islet Consortium.
Introduction: It is now well known and published TPIAT is effective as a treatment option for hereditary pancreatitis (HP), and it does improve quality of life for affected patients, hence accessibility should be maintained for all Australians. We undertook a financial audit of the costings of TPIAT in Australia.
Method: The initial stage was the collection of data surrounding the 15 patients who have undergone TPIAT in South Australia during the 6-year time period of 2017 til-now (April 2023). Data collected included the number of acute pancreatitis episodes leading to presentations to tertiary hospitals per year prior to TPIAT surgery, the medications required pre-TPIAT, the number of nights requiring Intensive Care (ICU) post-TPIAT, the incidence of complications and/or ‘return to theatre’ occurring during or post-TPIAT surgery, the overall length of admission, the incidence of re-admission, and medications required post-TPIAT surgery.
Results: Average costs of TPIAT of $204 438.63 Australian Dollars ($136 830.78 US Dollars), ranged to mean average cost of $352 052.72 ($235 742.22 US Dollars), to a least optimal cost of $494 119.21 ($330 873.05 US Dollars). The ongoing yearly expense of care post-TPIAT was $2939.86 ($1968.19 US Dollars).
The optimal costing of traditional medical management, without stenting of the pancreatic duct, was $123 136.38 ($82 454.82 US Dollars). The mean average costing of traditional medical management was estimated to be $619 526.64 per year ($414 848.62 US Dollars), and the least optimal costing of traditional medical management was $949 679.53 ($635 926.24 US Dollars).
The complications of HP are estimated to cost $8239.53 per year ($5517.37 US Dollars), and the expense of a two-year treatment of pancreatic cancer is estimated to be $32 816.52 ($21 974.66). The conversion of Australian dollars to US dollars was based on the conversion $1 AUD to $0.67 USD as at the 4th May 2023.
Conclusion: This audit has illustrated the economic value of TPIAT surgery in the treatment of severe HP in Australia’s healthcare system. TPIAT expense ranging from $200000 to $500000 compared with up to just below one million Australian dollars for traditional medical management. The comparative annual expense post-TPIAT under $3000 against yearly expense of over $8000 for traditional medical management for those who do not have TPIAT surgery for their severe disease. This information should be very useful for upcoming review and indexation of Australia’s Medicare system.
Kidney, Transplant and Diabetes Research Australia (KTDRA).
[1] SA Health
