Inpatient mortality and healthcare resource utilization of nontraumatic intracerebral hemorrhage complications in the US

2021 ◽  
pp. 1-10
Author(s):  
Christine Park ◽  
Lefko T. Charalambous ◽  
Zidanyue Yang ◽  
Syed M. Adil ◽  
Sarah E. Hodges ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Resource Utilization ◽  
Cerebral Edema ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Inpatient Mortality ◽  
Total Cost ◽  
Venous Thromboembolic Events ◽  
The Us ◽  
Tract Infections

OBJECTIVENontraumatic, primary intracerebral hemorrhage (ICH) accounts for 2 million strokes worldwide annually and has a 1-year survival rate of 50%. Recent studies examining functional outcomes from ICH evacuation have been performed, but limited work has been done quantifying the incidence of subsequent complications and their healthcare economic impact. The purpose of this study was to quantify the incidence and healthcare resource utilization (HCRU) for major complications that can arise from ICH.METHODSThe IBM MarketScan Research databases were used to retrospectively identify patients with ICH from 2010 to 2015. Complications examined included cerebral edema, hydrocephalus, venous thromboembolic events (VTEs), pneumonia, urinary tract infections (UTIs), and seizures. For each complication, inpatient mortality and HCRU were assessed.RESULTSOf 25,322 adult patients included, 10,619 (42%) developed complications during the initial admission of ICH: 22% had cerebral edema, 11% hydrocephalus, 10% pneumonia, 6% UTIs, 5% seizures, and 5% VTEs. The inpatient mortality rates at 7 and 30 days for each complication of ICH ranked from highest to lowest were hydrocephalus (24% and 32%), cerebral edema (15% and 20%), pneumonia (8% and 18%), seizure (7% and 13%), VTE (4% and 11%), and UTI (4% and 8%). Hydrocephalus had the highest total cost (median $92,776, IQR $39,308–$180,716) at 7 days post–ICH diagnosis and the highest cumulative total cost (median $170,839, IQR $91,462–$330,673) at 1 year post–ICH diagnosis.CONCLUSIONSThis study characterizes one of the largest cohorts of patients with nontraumatic ICH in the US. More than 42% of the patients with ICH developed complications during initial admission, which resulted in high inpatient mortality and considerable HCRU.

scholarly journals Healthcare Resource Utilization of Complications of Intracerebral Hemorrhage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lefko T Charalambous ◽  
Syed M Adil ◽  
Zidanyue Yang ◽  
Christine Park ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Resource Utilization ◽  
Cerebral Edema ◽  
Hospital Admissions ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Cost Comparison ◽  
Inpatient Cost ◽  
Venous Thromboembolic Events

Abstract INTRODUCTION Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality worldwide, with a 1-mo mortality rate between 30% and 50%. Our goal was to quantify additional healthcare resource utilization (HCRU) incurred by the US health system due to complications sustained during initial ICH hospital admissions, including a cost comparison of complications treated invasively vs noninvasively. METHODS The IBM MarketScan databases were used to retrospectively identify ICH patients and quantify the prevalence and HCRU of associated complications. HCRU variables included total service costs and length of hospital stay (LOS). Complications studied included cerebral edema, hydrocephalus, delayed ischemic stroke, venous thromboembolic events (VTE), infections (urinary tract infection (UTI) and pneumonia), and seizures. Invasive interventions included craniotomies/craniectomies and CSF diversion. Costs were assessed at 7, 30, 60, and 365 d post-ICH diagnosis for complications. RESULTS A total of 29 989 adult patients were included. Of those, 18 387 (61%) developed at least 1 complication during their initial ICH admission: 35% delayed ischemic stroke, 23% cerebral edema, 15% infections, 11% hydrocephalus, 5% seizures, and 5% VTE. Overall median LOS for all ICH was 5 d (IQR 2-10 d). Patients developing VTE had the longest median LOS at 17 d (IQR 8-27 d) and highest 7-d inpatient cost (median $67,222; IQR $24,384-157,919). Hydrocephalus had similar median LOS (15 d; IQR 6-23 d) and second highest median 7-d inpatient cost (median $59,553; IQR $22,129-143,835). Patients suffering cerebral edema, hydrocephalus, or delayed ischemic stroke requiring invasive treatments had higher costs at all times, especially during the first 7 d, with differences ranging from $61,852 for hydrocephalus to $84,699 for delayed ischemic stroke. CONCLUSION Delayed ischemic stroke and cerebral edema were the most common complications during initial ICH admission. VTE and hydrocephalus had the longest LOS and highest service costs at all times after diagnosis.

PP79 Impact Of Hidradenitis Suppurativa On Healthcare Resource Utilization

2019 ◽  
Vol 35 (S1) ◽  
pp. 52-52
Author(s):  
Larissa de Araujo Costa Andrade ◽  
Ricardo Moreira ◽  
Vinicius Vitale
Keyword(s):  
Health Services ◽  
Resource Utilization ◽  
Inpatient Care ◽  
Hidradenitis Suppurativa ◽  
Healthcare Resource ◽  
Unit Cost ◽  
Healthcare Resource Utilization ◽  
Public Healthcare ◽  
Strong Impact ◽  
Total Cost

IntroductionHidradenitis suppurativa (HS) is a debilitating, chronic inflammatory skin disease characterized by painful nodules and abscesses. HS has a strong impact on patient quality of life. In Brazil, the prevalence of HS is estimated at 0.4 percent. Medical and surgical treatments have low effectiveness and disease recurrence is common, which affects health system costs. This study aimed to assess how HS patients utilize medical care (emergency and inpatient care) in Brazil and to describe the all-cause costs.MethodsData were retrieved from a public healthcare claims database (DATASUS), which provides access to information regarding health services and costs. Data from DATASUS were used to perform a cost-identification analysis on patients with HS who used health services over a two-year period. A retrospective bottom-up approach was used to estimate direct costs, multiplying the amount of each medical resource consumed by its unit cost.ResultsOver the two-year period, 90 patients (16%) with HS received inpatient care (151 procedures) at a total cost of BRL 83,520 (USD 21,715). Surgeries were the most frequently performed (73% of total) and expensive procedures, costing BRL 73,122 (USD 19,011; 88% of total costs), followed by clinical treatments (BRL 8,354 [USD 2,172]; 10%), and physician consulting (BRL 1,659 [USD 431]; 2%). For the 500 patients treated in the emergency department (total cost BRL 3,027 [USD 787]), the most frequently received services were physician consulting (34%), nursing care (12%), and minor surgeries (11%). Each patient received, on average, three procedures over the two-year period.ConclusionsHS is a high-burden disease, as demonstrated by the high healthcare resource utilization among patients. Since DATASUS is a public database, the costs presented reflect a government reference price and do not consider local costs, which is a limitation of this study. Health managers should be aware of this finding, although further research is needed to investigate the effect of healthcare utilization on patient outcomes.

Healthcare resource utilization and costs associated with herpes zoster in the US

2016 ◽  
Vol 19 (10) ◽  
pp. 928-935 ◽  
Author(s):  
Barbara H. Johnson ◽  
Liisa Palmer ◽  
Justin Gatwood ◽  
Gregory Lenhart ◽  
Kosuke Kawai ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
The Us

scholarly journals Healthcare resource Utilization among Hispanic Adults relative to Non-Hispanic White Adults in the US

2015 ◽  
Vol 18 (3) ◽  
pp. A81
Author(s):  
M. Hopps ◽  
M. Udall ◽  
G. Makinson ◽  
M. McDonald ◽  
J. Mardekian
Keyword(s):  
Resource Utilization ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Hispanic Adults ◽  
The Us ◽  
White Adults ◽  
Hispanic White

scholarly journals Healthcare Resource Utilization with Rasburicase in the Management of Patients with Tumor Lysis in the Outpatient Setting: Results from a Community Oncology Cohort

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3401-3401
Author(s):  
Ali McBride ◽  
Melissa Hagan ◽  
Mei Xue ◽  
Robert E Smith
Keyword(s):  
Resource Utilization ◽  
Clinical Characteristics ◽  
Healthcare Resource ◽  
Outpatient Setting ◽  
Healthcare Resource Utilization ◽  
Inpatient Setting ◽  
Total Cost ◽  
Tumor Lysis ◽  
Chemotherapy Group ◽  
Community Oncology

BACKGROUND and OBJECTIVE: Tumor lysis syndrome (TLS), a potentially fatal oncologic complication, can have a significant clinical and economic impact to patients and the healthcare system. The aim of this analysis was to examine healthcare resource utilization in patients treated with rasburicase for the management of tumor lysis in the outpatient versus inpatient setting. METHODS: Adult patients were selected from the Integra Connect Database (IC) if they were treated with rasburicase between January 1, 2017 and March 31, 2019. The IC database comprises clinical and financial records for more than 750,000 community oncology patients, including 25,000 active Oncology Care Model participants representing approximately 20% of the unique beneficiaries in this Medicare model. Patients treated in the outpatient setting were divided into 3 groups: Primary Prophylaxis- treatment with rasburicase administered days 0-2 of chemotherapy (Group A), Early Reactive- rasburicase administered days 3-5 of chemotherapy (Group B), and Late Reactive- rasburicase administered after day 5 of chemotherapy (Group C). Inpatients were divided into 2 groups: Inpatient TLS Treatment- patients admitted and treated for TLS with rasburicase and who had not received rasburicase as part of their outpatient chemotherapy regimen (Group D) and Inpatient Chemotherapy- patients admitted for chemotherapy who were given rasburicase (Group E). Demographic, clinical characteristics including tumor types, lab values, and dose information were collected. Total cost of rasburicase was calculated as mean drug cost per patient. All variables were summarized descriptively as mean (SD), median (min and max) or counts (percentages). RESULTS: A total of 265 patients treated with rasburicase were included in the analysis. Of those, 189 patients received rasburicase in the outpatient setting vs 76 in the inpatient setting. None of the 189 patients in Groups A, B, and C who received outpatient rasburicase required admission due to TLS. Patient demographic and clinical characteristics, as well as rasburicase utilization, were similar between cohorts (Table 1 and Table 2). Our results show that while 54% of patients in Groups B, C, and D were initially treated with allopurinol, these patients were switched to rasburicase, indicating failure of allopurinol alone. The total cost of rasburicase trended lower in the outpatient vs inpatient setting ($9,287 vs $11,959). However, a more appropriate comparator to this cost is the published data for charges incurred for inpatient treatment of TLS, shown to be $151,9171 CONCLUSIONS: TLS continues to impact patients with diagnoses and chemotherapy regimens at intermediate and high risk for development of this syndrome. This study demonstrates that allopurinol is frequently inadequate and replacement with rasburicase is needed. We found rasburicase to be effective from both a clinical and a cost perspective in preventing TLS-related hospitalization. While rasburicase is most efficiently employed as primary prevention, close monitoring of patients allows effective reactive utilization evidenced by none of the outpatients in this study who received rasburicase were admitted for TLS. This study highlights the opportunity for greater utilization of rasburicase in the outpatient setting, as a means to lower the total cost of care. 1. Pathak et al. Blood. 2017; 130:3390 Disclosures McBride: teva: Consultancy; Sandoz: Consultancy; Sanofi Genzyme: Consultancy.

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