S172 Social Vulnerability and the Use of Pancreatic Enzyme Replacement Therapy for Exocrine Pancreas Insufficiency

Introduction: Pancreatic enzyme replacement therapy (PERT) is used to manage exocrine pancreatic insufficiency (EPI). However, since 2009 when formal FDA approval was required to market PERT products and subsequently the number of commercially available PERT products declined dramatically, the costs per prescription have skyrocketed. In this study, we analyzed patients’ scaling on the social vulnerability index impacted use of PERT. Methods: EPIC Cosmos was utilized for this research study. Cosmos is a dataset of de-identified patient data from all healthcare systems which utilize EPIC as their electronic medical record across the United States. Within Cosmos, the slicer-dicer tool was employed to first identify all patients with EPI who are taking PERT. From this subpopulation, the rates of PERT utilization were stratified social vulnerability index. Results: There were 299,800,751 unique patients in the Cosmos database. From all unique patients, 191,404 patients were identified as diagnosed with EPI. 128,458 patients (67.1%) were taking PERT. Those patients who could be classified by social vulnerability index (98,317) were stratified by decile. Between 65-68% of patients in each decile were taking PERT, indicating that there was no variance in PERT usage based on social vulnerability. The lowest percent of PERT use (65%) was seen in the most advantaged decile. Conclusion: While one-third of patients with EPI do not receive PERT, social vulnerability does not appear to be a factor in usage.