44 Ultrasonography as a First-line Imaging Modality for Appendicitis: Does It Reduce Health Care Costs, Radiation Exposure and Length of Stay in Emergency Department Patients?

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

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Real-World Assessment of Health Care Costs for Patients with Metastatic Pancreatic Cancer Following Initiation of First-Line Chemotherapy

Journal of Managed Care & Specialty Pharmacy ◽

10.18553/jmcp.2020.26.7.872 ◽

2020 ◽

Vol 26 (7) ◽

pp. 872-878

Author(s):

Andrea Bullock ◽

Christopher G. Rowan ◽

Nina Oestreicher ◽

Homa Yeganegi ◽

E. Gabriela Chiorean

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Health Care Costs ◽

Real World ◽

Metastatic Pancreatic Cancer ◽

First Line ◽

Care Costs ◽

Line Chemotherapy

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Journal Club: Multicenter study of health care costs of patients admitted to hospital with Staphylococcus aureus bacteremia: Impact of length of stay and intensity of care

American Journal of Infection Control ◽

10.1016/j.ajic.2015.03.030 ◽

2015 ◽

Vol 43 (7) ◽

pp. 745-746

Author(s):

Kathleen A. Gase ◽

James Davis

Keyword(s):

Health Care ◽

Staphylococcus Aureus ◽

Length Of Stay ◽

Health Care Costs ◽

Multicenter Study ◽

Journal Club ◽

Staphylococcus Aureus Bacteremia ◽

Intensity Of Care ◽

Care Costs

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Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253219888658 ◽

2019 ◽

Vol 24 (3) ◽

pp. 219-226 ◽

Cited By ~ 5

Author(s):

Keith B. Allen ◽

Ethan Y. Brovman ◽

Adnan K. Chhatriwalla ◽

Katherine J. Greco ◽

Nikhilesh Rao ◽

...

Keyword(s):

Health Care ◽

Cardiac Surgery ◽

Pain Management ◽

Length Of Stay ◽

Health Care Costs ◽

Adverse Drug Events ◽

Management Strategies ◽

Coronary Bypass ◽

Administrative Claims ◽

Care Costs

Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

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PP142-SUN: Home Enteral Nutrition (HEN) Helps to Reduce Complications, Length of Stay and Health-Care Costs in Adults

Clinical Nutrition ◽

10.1016/s0261-5614(14)50184-7 ◽

2014 ◽

Vol 33 ◽

pp. S73

Author(s):

S. Klek ◽

A. Hermanowicz ◽

G. Dziwiszek ◽

K. Matysiak ◽

K. Szczepanek ◽

...

Keyword(s):

Health Care ◽

Length Of Stay ◽

Enteral Nutrition ◽

Health Care Costs ◽

Home Enteral Nutrition ◽

Care Costs

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142 High and Low Frequency Emergency Department Users: A Comparative Analysis of Morbidity, Diagnostic Testing, and Health Care Costs

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.169 ◽

2011 ◽

Vol 58 (4) ◽

pp. S225 ◽

Cited By ~ 3

Author(s):

J. Oostema ◽

J. Troost ◽

K. Schurr ◽

R. Waller

Keyword(s):

Health Care ◽

Emergency Department ◽

Comparative Analysis ◽

Health Care Costs ◽

Diagnostic Testing ◽

Low Frequency ◽

Care Costs

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The effect of surgical site infection on the length of stay and health care costs

Health Policy and Management ◽

10.4332/kjhpa.2011.21.1.044 ◽

2011 ◽

Vol 21 (1) ◽

pp. 44-60 ◽

Cited By ~ 4

Author(s):

Jin-Hee Chang ◽

Kyoung-Hoon Kim ◽

Soon-Man Kwon ◽

Seon-A Yeom ◽

Choon-Seon Park

Keyword(s):

Health Care ◽

Length Of Stay ◽

Surgical Site Infection ◽

Health Care Costs ◽

Site Infection ◽

Care Costs

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Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.18.00122 ◽

2018 ◽

Vol 36 (33) ◽

pp. 3307-3314 ◽

Cited By ~ 18

Author(s):

Scott F. Huntington ◽

Gottfried von Keudell ◽

Amy J. Davidoff ◽

Cary P. Gross ◽

Sapna A. Prasad

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Health Care Costs ◽

Brentuximab Vedotin ◽

Stage Iii ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Line Setting ◽

Care Costs

Purpose In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. Patients and Methods We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. Results AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. Conclusion Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.

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