PIT23 THE COST BURDEN OF NONUNION FOLLOWING LONG BONE FRACTURE IN A COMMERCIALLY INSURED POPULATION IN THE UNITED STATES

Surgical site infections (SSIs) are among the most common types of postoperative complications in the United States and are associated with significant prevalence of morbidity and mortality in patients undergoing surgical interventions, especially in colorectal surgery (CRS) where SSI rates are significantly higher than those of similar operative sites. SSIs were identified from the National Inpatient Sample-Healthcare Cost and Utilization Project database from 2001 to 2012 based on the specification of an ICD-9 code. Propensity score matching was used to compare costs associated with SSI cases with those of non-SSI controls among elective and nonelective admissions. Results were projected nationally using Healthcare Cost and Utilization Project sampling methodology to evaluate the incidence of SSIs and ascertain the national cost burden retrospectively. Among 4,851,359 sample-weighted hospitalizations, 4.2 per cent (203,597) experienced SSI. Elective admissions associated with SSI-stayed hospitalized for an average of 7.8 days longer and cost $18,410 more than their counterparts who did not experience an SSI. Nonelective admissions that experienced an SSI had an 8.5-day longer hospital stay and cost $20,890 more than counterparts without perioperative infections. This represents a 3 per cent annual growth in costs for SSIs and seems to be largely driven by cost increases in treatment of SSIs for elective surgeries. Current efforts of SSI management after CRS focused on compliance with guidelines and tracking of infection rates would benefit from some improvements. Considering the growing costs and increase in resource utilization associated with SSIs from 2001 to 2012, further research on costs associated with management of SSIs specific to CRS is necessary.

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Secondary Polycythemia and the Risk of Venous Thromboembolism (VTE) Among Hospitalized Patients in the United States

Blood ◽

10.1182/blood.v128.22.1427.1427 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1427-1427 ◽

Cited By ~ 3

Author(s):

Smith Giri ◽

Kathan Dilipbhai Mehta ◽

Vijaya R. Bhatt

Keyword(s):

Hospital Stay ◽

Bone Fracture ◽

The United States ◽

Long Bone ◽

P Value ◽

Confounding Factors ◽

Long Bone Fracture ◽

History Of ◽

The Impact ◽

Secondary Polycythemia

Abstract Introduction:The prevalence of secondary polycythemia is on the rise due to increasing prevalence of obesity, sleep apnea and other chronic cardiopulmonary diseases. While polycythemia vera is well known to increase the risk of VTE, the impact of secondary polycythemia on the development of VTE is less clear. Methods: We utilized the Nationwide Inpatient Sample (NIS) database to identify all adults ≥18 years with secondary polycythemia (ICD-9-CM code 289.0) diagnosed during 2011. NIS is the largest all-payer inpatient database in the US that captures about 20% of all US hospitalizations. The outcome of interest was acute VTE identified using corresponding ICD codes for DVT or PE. We also identified the presence of the following confounding factors: malignancy, venous catheterization, long bone fracture, infection, trauma, mechanical intubation, congestive heart failure (CHF), pregnancy, length of hospital stay >5 days, stroke and prior history of VTE. Multivariate logistic regression was used to assess the impact of secondary polycythemia on the occurrence of VTE controlling the above confounding factors. Multicollinearity was assessed using variance inflation factor (VIF). All p-values were 2 sided, and the level of significance was chosen at 0.05. Statistical analysis was done using STATA 13.0 (StataCorp, College Station, TX) taking into account the complex sampling design of the database. Results: A total of 3,972 hospitalizations with a primary or secondary diagnosis of secondary polycythemia were identified out of a total of 6,840,854 hospitalizations. Concurrent diagnosis of VTE was seen in 4.8% of patients with secondary polycythemia (n=190) as opposed to 2.3% of patients without secondary polycythemia (n=161,122) (odds ratio, OR 2.07; 95% confidence interval, CI 1.75-2.45; p value <0.01). In a multivariate analysis, secondary polycythemia continued to have a significantly greater risk of concurrent VTE (adjusted OR 1.87; 95% CI 1.58-2.22; p value <0.01) after adjusting for confounders including age, stroke, malignancy, infection, history of VTE, long bone fracture, trauma, CHF, pregnancy, mechanical intubation, nephrotic syndrome and hospital stay >5 days. No evidence of multicollinearity was noted in the final regression model (maximum VIF of 1.13). Conclusion: Within the limitations of the study design, our retrospective study indicates an independent association between secondary polycythemia and VTE in patients admitted in the hospital, however, this does not imply causality. Further, our study does not answer whether the use of therapeutic phlebotomy reduces the risk of VTE in patients with secondary polycythemia. Disclosures No relevant conflicts of interest to declare.

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The cost burden of multiple sclerosis in the United States: a systematic review of the literature

Journal of Medical Economics ◽

10.3111/13696998.2013.778268 ◽

2013 ◽

Vol 16 (5) ◽

pp. 639-647 ◽

Cited By ~ 101

Author(s):

Gabriel Adelman ◽

Stanley G. Rane ◽

Kathleen F. Villa

Keyword(s):

United States ◽

Multiple Sclerosis ◽

Systematic Review ◽

The United States ◽

Cost Burden ◽

Review Of The Literature ◽

The Cost

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Trends of Hospitalization in Acute Pancreatitis in Patients in the United States from 2001-2014

10.1101/547273 ◽

2019 ◽

Author(s):

Kevin Casey ◽

Roberto Argo ◽

Albert Bianco

Keyword(s):

United States ◽

Acute Pancreatitis ◽

Hospital Admissions ◽

Length Of Hospital Stay ◽

The United States ◽

Primary Objective ◽

Hospital Charges ◽

Inhospital Mortality ◽

Cost Burden ◽

The Cost

ABSTRACTBackground & PurposeThe prevalence of acute pancreatitis(AP) has increased over time and is one of the most important gastrointestinal causes of frequent admissions to hospital in the United States. The cost burden of AP has been steadily increasing. The primary objective of our study was to analyze patient demographics, cost burden, mortality and length of stay associated with AP hospital admissions.MethodsNationwide inpatient sample (NIS) database was used to identify AP admissions in all patients from ≥18 years of age from 2001 to 2014 using ICD-9-CM code 577.0 as the principal discharge diagnosisResultsThe number of hospitalizations increased from 215,238 in 2001 to 279,145 in 2014. Inhospital mortality decreased from 1.74% in 2001 to 0.66% in 2014. Mean length of hospital stay has decreased from 6.1 days to 4.6 days during the same period, but the mean hospital charges increased from $19,303 in 2001 to $35,728 in 2014. The proportion of males to females with acute pancreatitis is slowly trending up from 2001 to 2014.ConclusionThe number of hospitalizations due to acute pancreatitis has been steadily increasing, and further research needs to be done on finding out the reasons for increased causes of hospitalization and ways to decrease the cost burden on patients and hospitals.

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Conservative Care Cost Analysis of Patients of Long Bone Fracture in Emergency Room. A Review to See the Sufficiency of Health Insurance Costs

Medical and Health Science Journal ◽

10.33086/mhsj.v4i2.1537 ◽

2020 ◽

Vol 4 (2) ◽

pp. 87-90

Author(s):

Bayusentono Sulis ◽

Cery Hajali

Keyword(s):

Length Of Stay ◽

Bone Fracture ◽

Bone Fractures ◽

Long Bone ◽

Long Bones ◽

Inclusion Criteria ◽

Real Cost ◽

Long Bone Fractures ◽

Long Bone Fracture ◽

The Cost

Long bones are bones that include the humerus, radius, ulna, femur, tibia and fibula. Aside from fibula, the main function of long bones is as the main skeleton in movement. Therefore, whenever there is a fracture in the long bone, the ability to move will be lost.The occurrence of this long bone fracture itself is still a global problem because the number of events is still quite large. This is in line with the increase in socioeconomic status and the incidence of traffic accidents which is one of the causes of fractures. METHOD This study is a prospective study to determine the magnitude of the cost of treatment conservatively in cases of long bone fractures in RSUD dr. Soetomo. The study design used was a prospective cohort. The sample size used in this study was determined by consecutive sampling, ie patients who met the inclusion criteria in the period May - August 2017. RESULTS From the observations for four months from May 2017 - August 2017 at Emergency Room Soetomo General Hospital, found 77 patients with long bone fractures that were casted. Of these patients, 38 patients were placed in a slab, 39 patients were placed in a circular cast. Among the 39 people, 17 patients were excluded according to the exclusion criteria and 22 patients were included as the study sample according to the inclusion criteria. By using a statistical test using paired sample T test with a value of α = 0.05, a significance of 0.025 was obtained. Because the significance value is 0.025 <0.05 (α). DISCUSSION From the resultsa difference between the BPJS rate of installing circular cast on long bone fractures with the real cost of installing circular cast on long bone fractures. In addition, from the value of the mean we get that the average value of the BPJS rate is greater than the real cost value, which means we can conclude that the BPJS cost can cover the cost of conservative therapy in cases of long bone fractures. CONCLUSION In the economic aspect, the longer the length of stay means the higher the costs that must be paid by the patient (the payer) and accepted by the hospital. This only applies to real tariffs, whereas to INACBG's long or short length of stay does not affect the cost.

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Trends of Hospitalization in Acute Pancreatitis in Patients in the United States from 2001-2014

10.31219/osf.io/zd8ab ◽

2019 ◽

Author(s):

Kevin Casey ◽

Roberto Argo ◽

Albert Bianco

Keyword(s):

United States ◽

Acute Pancreatitis ◽

Length Of Hospital Stay ◽

The United States ◽

Primary Objective ◽

Hospital Charges ◽

Cost Burden ◽

Patient Demographics ◽

The Mean ◽

The Cost

Background & Purpose: The prevalence of acute pancreatitis(AP) has increased over time and is one of the most important gastrointestinal causes of frequent admissions to hospital in the United States. The cost burden of AP has been steadily increasing. The primary objective of our study was to analyze patient demographics, cost burden, mortality and length of stay associated with AP hospital admissions.Methods: Nationwide inpatient sample (NIS) database was used to identify AP admissions in all patients from ≥18 years of age from 2001 to 2014 using ICD-9-CM code 577.0 as the principal discharge diagnosisResults: The number of hospitalizations increased from 215,238 in 2001 to 279,145 in 2014. In-hospital mortality decreased from 1.74% in 2001 to 0.66% in 2014. Mean length of hospital stay has decreased from 6.1 days to 4.6 days during the same period, but the mean hospital charges increased from $19,303 in 2001 to $35,728 in 2014. The proportion of males to females with acute pancreatitis is slowly trending up from 2001 to 2014. Conclusion: The number of hospitalizations due to acute pancreatitis has been steadily increasing, and further research needs to be done on finding out the reasons for increased causes of hospitalization and ways to decrease the cost burden on patients and hospitals.

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National Trends in the Cost Burden of Pediatric Gunshot Wounds Across the United States

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.05.018 ◽

2021 ◽

Author(s):

Sonam Sidhu ◽

Ava Mandelbaum ◽

Vishal Dobaria ◽

Catherine G. Williamson ◽

Zachary Tran ◽

...

Keyword(s):

United States ◽

Gunshot Wounds ◽

The United States ◽

Cost Burden ◽

National Trends ◽

The Cost

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Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157864 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7864

Author(s):

Minaal Farrukh ◽

Haneen Khreis

Keyword(s):

United States ◽

Air Pollution ◽

Economic Impact ◽

Childhood Asthma ◽

Ambient Air ◽

The United States ◽

The State ◽

Cost Calculation ◽

Cost Burden ◽

Incident Cases

Background: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. Objective: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. Methods: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. Results: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20–$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62–$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06–$144,269.18). Conclusion: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP’s impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population’s exposure.

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Systemic and local cardiac inflammation after experimental long bone fracture, traumatic brain injury and combined trauma in mice

Journal of Orthopaedic Translation ◽

10.1016/j.jot.2020.12.003 ◽

2021 ◽

Vol 28 ◽

pp. 39-46

Author(s):

Ina Lackner ◽

Birte Weber ◽

Melanie Haffner-Luntzer ◽

Simona Hristova ◽

Florian Gebhard ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Bone Fracture ◽

Long Bone ◽

Cardiac Inflammation ◽

Long Bone Fracture

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SWK-11. ASSESSMENT OF THE INDIRECT COSTS ASSOCIATED WITH PROTON THERAPY TREATMENT FOR ALBERTA PATIENTS REFERRED OUT OF COUNTRY

Neuro-Oncology ◽

10.1093/neuonc/noaa222.828 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii466-iii466

Author(s):

Karina Black ◽

Jackie Middleton ◽

Sunita Ghosh ◽

David Eisenstat ◽

Samor Patel

Keyword(s):

United States ◽

Proton Therapy ◽

Malignant Tumors ◽

Indirect Costs ◽

The United States ◽

Current Data ◽

Opportunity Costs ◽

Proton Treatment ◽

Out Of Pocket Expenses ◽

The Cost

Abstract BACKGROUND Proton therapy for benign and malignant tumors has dosimetric and clinical advantages over photon therapy. Patients in Alberta, Canada are referred to the United States for proton treatment. The Alberta Heath Care Insurance Plan (AHCIP) pays for the proton treatment and the cost of flights to and from the United States (direct costs). This study aimed to determine the out-of-pocket expenses incurred by patients or their families (indirect costs). METHODS Invitation letters linked to an electronic survey were mailed to patients treated with protons between 2008 and 2018. Expenses for flights for other family members, accommodations, transportation, food, passports, insurance, and opportunity costs including lost wages and productivity were measured. RESULTS Fifty-nine invitation letters were mailed. Seventeen surveys were completed (28.8% response rate). One paper survey was mailed at participant request. Nine respondents were from parent/guardian, 8 from patients. All patients were accompanied to the US by a family member/friend. Considerable variability in costs and reimbursements were reported. Many of the accompanying family/friends had to miss work; only 3 patients themselves reported missed work. Time away from work varied, and varied as to whether it was paid or unpaid time off. CONCLUSIONS Respondents incurred indirect monetary and opportunity costs which were not covered by AHCIP when traveling out of country for proton therapy. Prospective studies could help provide current data minimizing recall bias. These data may be helpful for administrators in assessing the societal cost of out-of-country referral of patients for proton therapy.

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