Palliation Tied to Lower Hospitalization Costs

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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Regional and Racial Variation in Hospitalization Costs in Patients with Duchenne Muscular Dystrophy

10.1542/peds.140.1_meetingabstract.28 ◽

2017 ◽

Author(s):

Sareh Zahedieh ◽

Michael Seckeler ◽

Jennifer Andrews ◽

Scott E. Klewer ◽

Katalin Scherer ◽

...

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Racial Variation ◽

Hospitalization Costs

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Association of Hospital Safety Net Status With Outcomes and Resource Use for Extracorporeal Membrane Oxygenation in the United States

Journal of Intensive Care Medicine ◽

10.1177/08850666211007062 ◽

2021 ◽

pp. 088506662110070

Author(s):

Matthew Gandjian ◽

Catherine Williamson ◽

Yu Xia ◽

Carlos Maturana ◽

Nikhil Chervu ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Resource Use ◽

Safety Net ◽

The United States ◽

Infectious Complications ◽

Membrane Oxygenation ◽

Hospital Safety ◽

Hospitalization Costs ◽

National Cohort ◽

Multivariable Regression

Purpose: Safety net hospitals (SNH) have been associated with inferior surgical outcomes and increased resource use. Utilization and outcomes for extracorporeal membrane oxygenation (ECMO), a rescue modality for patients with respiratory or cardiac failure, may vary by safety net status. We hypothesized SNH to be associated with inferior outcomes and costs of ECMO in a national cohort. Materials and Methods: The 2008-2017 National Inpatient Sample was queried for ECMO hospitalizations and safety net hospitals were identified. Multivariable regression was used to perform risk-adjusted comparisons of mortality, complications and resource utilization at safety net and non-safety net hospitals. Results: Of 36,491 ECMO hospitalizations, 28.2% were at SNH. On adjusted comparison SNH was associated with increased odds of mortality (AOR: 1.23), tracheostomy use (AOR: 1.51), intracranial hemorrhage (AOR: 1.39), as well as infectious complications (AOR: 1.21, all P < .05), with NSNH as reference. SNH was also associated with increased hospitalization duration (β=+4.5 days) and hospitalization costs (β=+$32,880, all P < .01). Conclusions: We have found SNH to be associated with inferior survival, increased complications, and higher costs compared to NSNH. These disparate outcomes warrant further studies examining systemic and hospital-level factors that may impact outcomes and resource use of ECMO at SNH.

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101 Maternal and neonatal hospitalization costs associated with gestational weight gain

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.123 ◽

2021 ◽

Vol 224 (2) ◽

pp. S71

Author(s):

Alyssa R. Hersh ◽

Brooke F. Mischkot ◽

Bharti Garg ◽

Alexie A. Carletti ◽

Aaron B. Caughey

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Weight ◽

Hospitalization Costs

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Healthcare Expenditures Associated with Heart Failure in Saudi Arabia: A Cost of Illness Study

Healthcare ◽

10.3390/healthcare9080988 ◽

2021 ◽

Vol 9 (8) ◽

pp. 988

Author(s):

Ahmed Alghamdi ◽

Eman Algarni ◽

Bander Balkhi ◽

Abdulaziz Altowaijri ◽

Abdulaziz Alhossan

Keyword(s):

Heart Failure ◽

Saudi Arabia ◽

Cost Of Illness ◽

Economic Burden ◽

Indirect Costs ◽

Health Care Expenditures ◽

Decision Makers ◽

Hospitalization Costs ◽

Illness Study ◽

The Cost

Heart failure (HF) is considered to be a global health problem that generates a significant economic burden. Despite the growing prevalence in Saudi Arabia, the economic burden of HF is not well studied. The aim of this study was to estimate the health care expenditures associated with HF in Saudi Arabia from a social perspective. We conducted a multicenter cost of illness (COI) study in two large governmental centers in Riyadh, Saudi Arabia using 369 HF patients. A COI model was developed in order to estimate the direct medical costs associated with HF. The indirect costs of HF were estimated based on a human capital approach. Descriptive and inferential statistics were analyzed. The direct medical cost per HF patient was $9563. Hospitalization costs were the major driver in total spending, followed by medication and diagnostics costs. The cost significantly increased in line with the disease progression, ranging from $3671 in class I to $16,447 in class IV. The indirect costs per working HF patient were $4628 due to absenteeism, and $6388 due to presenteeism. The economic burden of HF is significantly high in Saudi Arabia. Decision makers need to focus on allocating resources towards strategies that prevent frequent hospitalizations and improve HF management and patient outcomes in order to lower the growing economic burden.

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The cost of waiting: Association of ED boarding with hospitalization costs

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.10.058 ◽

2020 ◽

Author(s):

Cristiana Baloescu ◽

Jeremiah Kinsman ◽

Shashank Ravi ◽

Vivek Parwani ◽

Rohit B. Sangal ◽

...

Keyword(s):

Hospitalization Costs ◽

The Cost

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Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1359 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Narasimhan ◽

K Ho ◽

L Wu ◽

M Amreia ◽

A Isath ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Hospital Admissions ◽

Obesity Paradox ◽

Index Admission ◽

Multivariate Logistic Regression Model ◽

Obese Patients ◽

Readmission Rates ◽

Coronary Syndrome ◽

Hospitalization Costs

Abstract Background The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients. Methods A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model. Results In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p<0.001) with significantly lower 30-day readmission rates as well (p<0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p<0.001). Conclusion In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age. Funding Acknowledgement Type of funding source: None

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Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

Pneumonia ◽

10.1186/s41479-020-00078-z ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Bisma Ali Sayed ◽

Drew L. Posey ◽

Brian Maskery ◽

La’Marcus T. Wingate ◽

Martin S. Cetron

Keyword(s):

United States ◽

Home Country ◽

Screening Program ◽

Cost Savings ◽

The United States ◽

Active Tuberculosis ◽

Multiple Perspectives ◽

Tuberculosis Screening ◽

Hospitalization Costs ◽

The U.S

Abstract Background While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. Objectives We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas. Methods We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) “Screening”: screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) “No Screening” in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives. Results Under “Screening” versus “No Screening”, an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs. Conclusion From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.

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Direct Health Care Costs Associated with Asthma in British Columbia

Canadian Respiratory Journal ◽

10.1155/2010/361071 ◽

2010 ◽

Vol 17 (2) ◽

pp. 74-80 ◽

Cited By ~ 69

Author(s):

Mohsen Sadatsafavi ◽

Larry Lynd ◽

Carlo Marra ◽

Bruce Carleton ◽

Wan C Tan ◽

...

Keyword(s):

Health Care ◽

British Columbia ◽

Asthma Control ◽

Health Care Costs ◽

Economic Burden ◽

Emergency Department Visits ◽

Common Disease ◽

Physician Visits ◽

Hospitalization Costs ◽

Care Costs

BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease.OBJECTIVE: To determine the direct medical costs of asthma-related health care in British Columbia (BC).METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation-adjusted 2006 Canadian dollars.RESULTS: Asthma resulted in $41,858,610 in annual health care-related costs during the study period ($331 per patient-year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma-related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient-year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma-related resource use.CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management.

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The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015

BMC Health Services Research ◽

10.1186/s12913-021-06335-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarina R. Isenberg ◽

Christopher Meaney ◽

Peter May ◽

Peter Tanuseputro ◽

Kieran Quinn ◽

...

Keyword(s):

Palliative Care ◽

Metastatic Cancer ◽

Estimating Equation ◽

Population Based ◽

Future Research ◽

Chronic Obstructive ◽

Discharge Abstract Database ◽

High Involvement ◽

Hospitalization Costs ◽

The Cost

Abstract Background Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Methods Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. Results There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). Conclusions Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

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