Award: ACG Outstanding Research Award in the Interventional Endoscopy Category (Trainee)
Robin Wilson, MD, Peter Fields, MD, Curtis Haas, PharmD, Vivek Kaul, MD, Asad Ullah, MD, Truptesh Kothari, MD, Ahmed Dirweesh, MD, Tanya Bruckel, MD, Myla Strawderman, MS, Shivangi Kothari, MD University of Rochester Medical Center, Rochester, NY
Introduction: Rectal NSAIDs are used as Post-ERCP Pancreatitis (PEP) prophylaxis based on high quality evidence. Indomethacin is commonly used for this purpose, but its cost has increased significantly in recent years. Diclofenac is a less costly alternative that has shown efficacy in reducing PEP rates. We aimed to compare PEP rates between patients who received these two medications and demonstrate the relative cost savings with diclofenac use.
Methods: We used pharmacy records for diclofenac and indomethacin suppository prescriptions to identify patients who had received these for PEP prophylaxis at our tertiary care center. Indomethacin use was recorded from 12/2022 to 5/2023, and diclofenac use was recorded from 6/2023 to 12/2023. We performed retrospective chart review to determine demographics, procedural complexity, and PEP rates. Univariate comparisons of patient characteristics between groups were performed by t-tests for continuous factors and chi-square tests for categorical factors. Unadjusted PEP rates were compared between characteristics using chi-square tests.
Results: 353 patients were included, of whom 171 (48.4%) received indomethacin and 182 (51.6%) received diclofenac. PEP rates were not significantly different between patients who received indomethacin {n=17 (9.9%, 95%CI=5.9–15.4)} vs. diclofenac {n=9 (4.9%, 95%CI=2.3–9.2)} (p=0.07). There were no significant differences in PEP rates based on age (p=0.78), gender (p=0.18), procedural indication (p=0.62), prior sphincter of Oddi dysfunction (p=0.11), prior recurrent pancreatitis (p=0.06), cannulation technique (p=0.16), or endoscopist (p=0.33). There were no significant differences between the diclofenac group and the indomethacin group in any of these fields. There was no significant association found between procedural difficulty as expressed by the Schutz score and the likelihood of developing PEP (p=0.20).
Each treatment with indomethacin cost $731.04 compared to $0.92 for diclofenac, entailing a total cost of $125,007.84 for indomethacin and $167.44 for diclofenac. Using diclofenac instead of indomethacin from 6/2023 to 12/2023 resulted in $132,881.84 of savings.
Discussion: At our tertiary care ERCP referral center, we found no significant difference in PEP rates between patients treated with rectal diclofenac instead of indomethacin for PEP prophylaxis. There are substantial cost savings associated with rectal diclofenac use. Larger studies can help confirm these findings.
Disclosures:
Robin Wilson indicated no relevant financial relationships.
Peter Fields indicated no relevant financial relationships.
Curtis Haas indicated no relevant financial relationships.
Robin Wilson, MD, Peter Fields, MD, Curtis Haas, PharmD, Vivek Kaul, MD, Asad Ullah, MD, Truptesh Kothari, MD, Ahmed Dirweesh, MD, Tanya Bruckel, MD, Myla Strawderman, MS, Shivangi Kothari, MD, 15, Efficacy and Cost Savings With Diclofenac Suppository for Post-ERCP Pancreatitis: Experience From a Tertiary Care Center, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
