Estimating medical costs of gastroenterological diseases

Table 1 Age-sex specific prevalence of gastroenterological dis-eases among cohorts (n = 183 976) in 2001

Age group in year	No. of patients			Prevalence in percent
	All	Female	Male	All	Female	Male
Sampling cohorta
< 20	51 029	24 644	26 384
20-39	63 800	32 115	31 670
40-59	45 432	23 061	22 371
≥ 60	23 715	11 574	12 141
Total	183 976	91 394	92 566
Patients with any gastroenterological diagnosis at both inpatient and
ambulatory sectorsbc
< 20	22 006	10 728	11 277	43.1	43.5	42.7
20-39	25 035	14 988	10 044	39.2	46.7	31.7
40-59	20 412	11 497	8 915	44.9	49.9	39.9
≥ 60	13 845	7 090	6 755	58.4	61.3	55.6
Total	81 298	44 303	36 991	44.2	48.5	40.0
Patients with any gastroenterological diagnosis at inpatient sector
< 20	947	388	559	1.9	1.6	2.1
20-39	792	301	491	1.2	0.9	1.6
40-59	1 056	431	625	2.3	1.9	2.8
≥ 60	1 738	737	1 001	7.3	6.4	8.2
Total	4 533	1 857	2 676	2.5	2.0	2.9
Patients with any gastroenterological diagnosis at ambulatory sectord
< 20	21 931	10 698	11 232	43.0	43.4	42.6
20-39	24 932	14 955	9 974	39.1	46.6	31.5
40-59	20 310	11 459	8 851	44.7	49.7	39.6
≥ 60	13 643	6 996	6 647	57.5	60.4	54.7
Total	80 816	44 108	3 6704	43.9	48.3	39.7
Patients with any gastroenterological diagnosis at clinics of traditional
Chinese medicine
< 20	1 833	1 005	828	3.6	4.1	3.1
20-39	3 608	2 259	1 349	5.7	7.0	4.3
40-59	2 892	1 687	1 205	6.4	7.3	5.4
≥ 60	1 310	731	579	5.5	6.3	4.8
Total	9 643	5 682	3 961	5.2	6.2	4.3

^aThose born after January 1, 2001 were not included in the cohort. The status of sex was unknown in 16 persons.

^b Pa-tients with gastroenterological diseases included 4 persons of unknown sex.

^cAll diagnoses of a patient during the year were taken into account, not confined to principal diagnosis at each admission or visit.

^dThe ambulatory sector included physician offices, hospital outpatient departments, and emergency de-partments of Western medicine, dentistry, and traditional Chi-nese medicine.

Table 2 Prevalence and costs of gastroenterological diseases among cohorts (n = 183 976) in 2001 by major disease category, according to principal diagnosis only

CSSacode	Single-level CCS diagnosiscategories	Patients		Total cost
		No.	Mean age (SD)	US $	%
6	Hepatitis	6 356	44.3 (16.1)	547 599	6.5%
12	Cancer of esophagus	67	47.4 (22.3)	193 853	2.3%
13	Cancer of stomach	110	64.0 (15.0)	207 765	2.5%
14	Cancer of colon	230	63.2 (14.3)	308 903	3.6%
15	Cancer of rectum and anus	180	65.9 (12.8)	328 540	3.9%
16	Cancer of liver and	242	60.5 (14.4)	448 114	5.3%
	intrahepatic bile duct
17	Cancer of pancreas	30	67.9 (13.4)	148 490	1.8%
18	Cancer of other	40	67.5 (11.5)	70 893	0.8%
	GI organs, peritoneum
120	Hemorrhoids	2 110	45.6 (17.1)	236 477	2.8%
135	Intestinal infection	7 727	25.3 (22.2)	175 479	2.1%
138	Esophageal disorders	967	46.9 (20.9)	145 264	1.7%
139	Gastroduodenal ulcer	6 214	48.1 (18.5)	898 028	10.6%
	(except hemorrhage)
140	Gastritis and duodenitis	14 112	36.7 (21.9)	348 621	4.1%
141	Other disorders of	7 736	38.7 (23.1)	285 697	3.4%
	stomach and duodenum
142	Appendicitis and other	362	33.1 (18.8)	217 212	2.6%
	appendiceal conditions
143	Abdominal hernia	515	35.6 (27.9)	228 586	2.7%
144	Regional enteritis	1 406	31.4 (22.5)	29 259	0.3%
	and ulcerative colitis
145	Intestinal obstruction	543	39.4 (29.3)	112 282	1.3%
	without hernia
146	Diverticulosis	45	58.2 (20.9)	29 713	0.4%
	and diverticulitis
147	Anal and rectal conditions	366	41.8 (21.4)	87 506	1.0%
148	Peritonitis and	72	49.5 (21.5)	54 941	0.6%
	intestinal abscess
149	Biliary tract disease	1 000	54.2 (17.5)	509 960	6.0%
150	Liver disease,	156	48.5 (12.3)	39 179	0.5%
	alcohol-related
151	Other liver diseases	2 102	47.7 (16.9)	569 503	6.7%
152	Pancreatic disorders	157	50.0 (17.0)	116 327	1.4%
	(not diabetes)
153	Gastrointestinal hemorrhage	1 385	52.4 (20.2)	442 493	5.2%
154	Noninfectious gastroenteritis	17 717	28.9 (21.9)	401 586	4.7%
155	Other gastrointestinal	16 080	36.7 (22.6)	563 336	6.7%
	disorders
214	Digestive congenital	84	31.2 (22.2)	15 785	0.2%
	anomalies
250	Nausea and vomiting	926	25.5 (24.3)	19 924	0.2%
251	Abdominal pain	14 113	34.4 (20.1)	404 085	4.8%
	Others	997	37.6 (23.1)	284 509	3.4%
	Total	67 073	34.8 (21.8)	8469 909	100.0%

^aCSS: Clinical Classifications Software by the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, USA.

Table 3 Utilization and costs of diagnostic procedures related to gastroenterological diseases among cohorts (n = 183 976) in 2001: top 20 by total cost

Item of diagnosticproceduresa	No. ofpatients	No. oforders	Total cost
			US $	%	Cum.%
Whole body computer	2 541	3 092	374 106	19.7%	19.7%
tomography (without contrast)
Abdominal sonography	11 132	15 730	349 690	18.4%	38.1%
Whole body computer tomography	1 644	2 106	320 943	16.9%	55.0%
(with/without contrast)
Upper GI panendoscopy	4 693	5 606	247 458	13.0%	68.0%
Serum GPT	25 427	47 523	69 765	3.7%	71.7%
Serum GOT	24 265	45 653	67 676	3.6%	75.2%
Whole body computer	337	437	59 522	3.1%	78.3%
tomography (with contrast)
Colon fiberoscopy	730	780	50 698	2.7%	81.0%
Double-contrast study	421	432	29 421	1.5%	82.6%
of lower GI series
AFP (RIA)	1 461	2 408	28 361	1.5%	84.1%
AFP (EIA)	2 363	3 570	20 86	1.1%	85.2%
Plain abdomen X-ray	2 338	2 856	18 498	1.0%	86.1%
Serum bilirubin, total	6 345	12 553	18 307	1.0%	87.1%
HbsAg (EIA)	3 678	3 999	17 237	0.9%	88.0%
Serum albumin	6 989	14 638	15 522	0.8%	88.8%
CEA (EIA)	856	1 308	15 293	0.8%	89.6%
Alkaline phosphatase	5 686	10 091	14 159	0.7%	90.4%
Upper GI series	296	315	13 347	0.7%	91.1%
CEA (RIA)	647	1 127	13 344	0.7%	91.8%
Sigmoid fiberoscopy	311	327	11 620	0.6%	92.4%
Others			144 922	7.6%	100.0%
Totalb	36 004	210 156	1 900 752	100.0%

^aMagnet resonance imaging (MRI) was excluded from analy-sis because the fee schedule of the National Health Insurance did not differentiate MRI for abdomen from MRI for other body parts.

^bNumbers might not add to totals because of rounding.

Table 4 Utilization and costs of therapeutic procedures (treatment and surgery) related to gastroenterological diseases among cohorts (n = 183 976) in 2001

Item of therapeutic procedure	No. ofpatients	No. oforders	Total cost
			US $	%	Cum.%
Nasal feeding	917	28 352	167 762	15.7%	15.7%
Repair of inguinal hernia	322	359	94 046	8.8%	24.5%
(without bowel resection)
Appendectomy	226	226	74 145	7.0%	31.5%
Laparoscopic cholecystectomy	83	84	68 081	6.4%	37.9%
Hemorrhoidectomy,	198	199	59 994	5.6%	43.5%
internal & external
Trans-arterial embolization (T.A.E.)	65	96	57 634	5.4%	48.9%
Insertion of nasogastric tube	1 745	5 370	25 609	2.4%	51.3%
Heat probe during endoscopy	162	185	21 893	2.1%	53.4%
Cholecystectomy	58	58	18 485	1.7%	55.1%
Eendoscopic papillectomy	31	32	17 893	1.7%	56.8%
Colonoscopic polypectomy	153	157	17 140	1.6%	58.4%
Internal hemorrhoid ligation	216	356	16 795	1.6%	60.0%
Gastric decompression	900	3 712	16 473	1.5%	61.5%
Percutaneous transhepatic	38	54	15 735	1.5%	63.0%
cholangiography drainage (PTCD)
Choledocholithotomy with	28	28	15 282	1.4%	64.4%
T-tube drainage
Radical gastrectomy	14	14	15 061	1.4%	65.8%
Radical proctectomy	11	11	14 723	1.4%	67.2%
Radical hemicolectomy with	23	23	13 973	1.3%	68.5%
ascending colon anastomosis
Restorative proctectomy with	11	11	13 948	1.3%	69.8%
colo-anal anastomosis
Vagotomy and pyloroplasty	20	20	13 911	1.3%	71.1%
Others			307 915	28.9%	100.0%
Totala	8 349	60 245	1 066 497	100.0%

^aNumbers might not add to totals because of rounding.

Table 5 Utilization and costs of drugs related to gastroenterological diseases among cohorts (n = 183 976) in 2001, by the fourth level of ATC classification system

ATC code	Drug group name	No. of patients	No. of orders	Total cost
				US $	%	Cum. %
A02BA	H2-receptor antagonists	26 690	85 228	269 851	17.4%	17.4%
A02BC	Proton pump inhibitors	2 223	7 100	219 823	14.2%	31.6%
A02AF	Antacids with antiflatulents	98 197	385 623	156 244	10.1%	41.6%
A05BA	Liver therapy	3 234	12 990	113 482	7.3%	49.0%
A02AD	Combinations and complexes of aluminium,	83 569	305 357	108 399	7.0%	55.9%
	calcium and magnesium compounds
A03FA	Propulsives	46 418	140 278	108 006	7.0%	62.9%
A02AB	Aluminium compounds	20 845	50 850	71 820	4.6%	67.5%
A06AB	Contact laxatives	8 775	37 266	59 022	3.8%	71.3%
A02AG	Antacids with antispasmodics	53 966	160 086	52 394	3.4%	74.7%
A06AC	Bulk producers	2 327	5 851	47 848	3.1%	77.8%
A09AA	Enzyme preparations	15 041	37 149	35 754	2.3%	80.1%
A03AA	Synthetic anticholinergics, esters with	19 071	43 779	28 953	1.9%	82.0%
	tertiary amino group
A07EC	Aminosalicylic acid and similar agents	248	1 504	24 494	1.6%	83.6%
A03AX	Other synthetic anticholinergic agents	2 264	4 110	22 682	1.5%	85.0%
A04AA	Serotonin (5HT3) antagonists	108	375	22 612	1.5%	86.5%
A02DA	Antiflatulents	38 126	97 683	16 448	1.1%	87.5%
A03AB	Synthetic anticholinergics, quaternary	8 413	15 312	16 205	1.0%	88.6%
	ammonium compounds
A03BB	Belladonna alkaloids, semisynthetic,	20 940	39 494	15 415	1.0%	89.6%
	quaternary ammonium compounds
A06AD	Osmotically acting laxatives	513	1 485	15 401	1.0%	90.6%
A05AA	Bile acid preparations	409	1 580	15 064	1.0%	91.5%
	Others			131 330	8.5%	100.0%
	Totala	149 062	1719 500	1 551 250	100.0%

^aNumbers might not add to totals because of rounding.