Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis

BackgroundMiddle meningeal artery (MMA) embolization results in fewer treatment failures than surgical evacuation for chronic subdural hematomas (cSDHs). We compared the total 1-year hospital cost for MMA embolization versus surgical evacuation for patients with cSDH.MethodsData for patients who presented with cSDHs from January 1, 2018, through May 31, 2020, were retrospectively reviewed. Patients were grouped by initial treatment (surgery vs MMA embolization), and total hospital cost was obtained. A propensity-adjusted analysis was performed. The primary outcome was difference in mean hospital cost between treatments.ResultsOf 170 patients, 48 (28%) underwent embolization and 122 (72%) underwent surgery. cSDHs were larger in the surgical (20.5 (6.7) mm) than in the embolization group (16.9 (4.6) mm; P<0.001); and index hospital length of stay was longer in the surgical group (9.8 (7.0) days) than in the embolization group (5.7 (2.4) days; P<0.001). More patients required additional hematoma treatment in the surgical cohort (16%) than in the embolization cohort (4%; P=0.03), and more required readmission in the surgical cohort (28%) than in the embolization cohort (13%; P=0.04). After propensity adjustment, MMA embolization was associated with a lower total hospital cost compared to surgery (mean difference −$32 776; 95% CI −$52 766 to −$12 787; P<0.001). A propensity-adjusted linear regression analysis found that unexpected additional treatment was the only significant contributor to total hospital cost (mean difference $96 357; 95% CI $73 886 to $118 827; P<0.001).ConclusionsMMA embolization is associated with decreased total hospital cost compared with surgery for cSDHs. This lower cost is directly related to the decreased need for additional treatment interventions.

Hospital costs of Balloon Pulmonary Angioplasty (BPA) procedure and management for CTEPH patients: An observational study based on the French national hospital discharge database (PMSI)

Introduction Since 2014, Balloon Pulmonary Angioplasty (BPA) has become an emerging and complementary strategy for chronic thromboembolic hypertension (CTEPH) patients who are not suitable for pulmonary endarterectomy (PEA) or who have recurrent symptoms after the PEA procedure. Objective To assess the hospital cost of BPA sessions and management in CTEPH patients. Methods An observational retrospective cohort study of CTEPH-adults hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 was conducted in the 2 centres performing BPA in France (Paris Sud and Grenoble) using the French national hospital discharge database (PMSI-MCO). Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from last BPA procedure stay and length of stay. Hospital costs (including medical transports) were estimated from National Health Insurance perspective using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. Results A total of 191 patients were analysed; mainly male (53%), with a mean age of 64,3 years. The first BPA session was performed 1.1 years in median (IQR 0.3–2.92) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 8 days for the first stay and 6 days for successive stays. The total hospital cost attributable to BPA was € 4,057,825 corresponding to €8,764±3,435 per stay and €21,245±12,843 per patient. Results were sensitive to age classes, density of commune of residence and some comorbidities. Conclusions The study generated robust real-world data to assess the hospital cost of BPA sessions and management in CTEPH patients within its first years of implementation in France.

Healthcare Resource Utilization and Costs in US Patients with Newly Diagnosed Acute Myeloid Leukemia Treated with Intensive Induction Chemotherapy

INTRODUCTION: Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy. In the United States (US) in 2020, the incidence of AML was 4.3/100,000, with a death rate of ~2.8 per 100,000. Following diagnosis, for patients who are fit for high-dose therapy, standard of care consists of initial intensive remission-inducing chemotherapy followed by post-remission therapy comprising consolidation chemotherapy alone, hematopoietic stem cell transplantation (HSCT) alone, or consolidation chemotherapy followed by HSCT. Despite an initial response to treatment, most patients with AML progress, and relapse is common. Relapse in AML is associated with poor prognosis, substantial healthcare resource utilization (HCRU), and a cost burden. Maintenance therapy with newer agents may delay relapse and prolong survival. Understanding HCRU and costs of newly diagnosed AML may inform clinicians, policy makers, and payers on the burden of AML and the potential clinical and economic benefits of novel therapies. This retrospective study describes HCRU and costs for patients with newly diagnosed AML receiving intensive induction chemotherapy in the US. METHODS: The Premier Healthcare Database was used to identify patients aged ≥18 years with an inpatient hospitalization or hospital-based outpatient visit (01/01/2016-03/31/2019), an AML diagnosis (ICD-10-CM diagnosis codes: C92.00, C92.40, C92.50, C92.60, C92.A0), who received CPX-351 or 7+3 treatments, and had ≤280 days from the end of first induction treatment to remission. Patients with prior AML diagnosis or those receiving other treatments were excluded. Index date was the admission date for the first hospitalization or the first hospital-based outpatient visit with an AML diagnosis. Patients were followed until death, relapse or last known follow-up, whichever was first. Unadjusted descriptive analyses were performed for patient demographics, baseline clinical characteristics, outpatient days, inpatient hospitalizations, intensive care unit (ICU) admissions, and costs. RESULTS: Overall, 642 patients who received induction chemotherapy for newly diagnosed AML were identified. Mean (median) patient age was 53.7 (56.0) years, and 53.1% of patients were male. Patients had commercial (47.2%), Medicare (26.8%), Medicaid (17.6%), or other (8.4%) insurance. Mean (SD) Charlson Comorbidity Index was 3.5 (2.2), and the most common comorbidities were diabetes (20.3%), chronic pulmonary disease (15.4%), and congestive heart failure (9.4%). Most frequent adverse events were pyrexia (47.2%), neutropenia (39.9%), sepsis (28.0%), pneumonia (24.3%), and fungal infection (17.9%). Median (interquartile range [IQR]) time from the end of first induction chemotherapy to remission was 58 (40-90) days. Median (IQR) time from remission to relapse was 274 (141-389) days. A total of 385 (60.0%) patients had outpatient service days at a Premier facility; median (IQR) number of outpatient service days per patient was 3 (1-6), outpatient hospital cost per visit was $1,083 ($481-$2,189), and total outpatient hospital cost was $2,904 ($1,054-$7,217). All patients had an inpatient hospitalization; median (IQR) number of inpatient hospitalizations per patient was 2 (2-3), length of stay (LOS) per inpatient hospitalization was 16 (13-21) days, cost per inpatient hospitalization was $34,558 ($25,419-$49,460), and total inpatient hospital cost was $83,440 ($63,067-$113,985). A total of 144 (22.4%) patients had an ICU admission; median (IQR) number of ICU admissions per patient was 1 (1-1), LOS per ICU admission was 3 (2-8) days, cost per ICU visit was $15,771 ($7,209-$27,564), and ICU cost was $16,550 ($7,368-$36,968). CONCLUSIONS: In the US, healthcare costs for patients with newly diagnosed AML who receive induction chemotherapy are considerable, primarily due to high HCRU and lengthy inpatient stays. Patient response to induction therapy and duration of remission may also contribute to HCRU and costs. More tolerable therapies that improve remission rate and duration, and/or reduce hospitalization rates, may alleviate the economic burden of AML. Disclosures Huggar: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Knoth: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Copher: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Cao: Premier, Inc.: Current Employment; BeiGene, Ltd.: Consultancy. Lipkin: Premier, Inc.: Current Employment. McBride: Bristol Myers Squibb: Current Employment. LeBlanc: Amgen: Consultancy, Other: travel; BMS/Celgene: Consultancy, Honoraria, Other: Travel fees, Research Funding, Speakers Bureau; Flatiron: Consultancy, Other: Advisory board; Astellas: Consultancy, Honoraria, Other: Advisory board; Duke University: Research Funding; American Cancer Society: Research Funding; Helsinn: Consultancy, Research Funding; AstraZeneca: Consultancy, Honoraria, Other: Advisory board, Research Funding; Heron: Consultancy, Honoraria, Other: advisory board; Agios: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; Pfizer: Consultancy, Other: Advisory Board; CareVive: Consultancy, Other, Research Funding; Seattle Genetics: Consultancy, Other: Advisory board, Research Funding; Jazz Pharmaceuticals: Research Funding; Otsuka: Consultancy, Honoraria, Other; Daiichi-Sankyo: Consultancy, Honoraria, Other: Advisory board; AbbVie: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; UpToDate: Patents & Royalties; NINR/NIH: Research Funding.

Abstract 1122‐000065: Hospital Cost of DTAS Compared to ED Transfers for LVOs Undergoing Mechanical Thrombectomy

Introduction : Direct‐to‐angiography‐suite (DTAS) transfer for patients with large vessel occlusions (LVOs) undergoing mechanical thrombectomy is associated with decreased workflow times and improved neurological outcomes. Herein, we sought to demonstrate a decrease in hospital cost associated with DTAS compared to emergency department (ED) transfers for patient undergoing mechanical thrombectomy for an LVO. Methods : A retrospective analysis was performed on all patients who underwent mechanical thrombectomy for an LVO at a single comprehensive stroke center between January 1st, 2017, and March 31st, 2021. All patients who were either transferred DTAS or ED were included and compared. Total hospital cost (sum of overhead, professional, diagnostic, and room charges throughout the entire index patient admission) was obtained from the hospital financial department for the index treatment admission. A propensity adjusted (matched for age, sex, vessel occluded, co‐morbidities, BMI, admission NIHSS, access site, and use of a stent retriever) was implemented. Mean difference in hospital cost following adjustment was the primary outcome. Results : During the study period, 341 patients underwent mechanical thrombectomy for an LVO. Of these patients, 140 (41%) were transferred DTAS and 96 (28%) to the ED. There were no significant differences between cohorts in terms of age, sex, vessel occluded, admission NIHSS, co‐morbidities, number of passes, TICI score, access site, stent retriever, major complications, or in‐hospital mortality. The DTAS cohort ($33,061, sD $17,258) had a significantly lower hospital cost compared to ED transferred patients ($38,030, sD $18,572) (p = 0.04). There was no significant difference between the ED (12.2, sD 11.8) and DTAS (11.6, sD 11.1) cohorts in discharge NIHSS. Following propensity score adjustment, linear regression analysis found DTAS (compared to ED transfer) to be significantly associated with a decrease in hospital cost ($‐6,344; 95% CI: $‐11,067 to $‐1,623; p = 0.009). Conclusions : DTAS transfer for patients undergoing an acute mechanical thrombectomy for a LVO was associated with a greater than $6,000 decrease total hospital cost compared to patients first transferred to the ED. The present study further supports DTAS transfer for patients undergoing mechanical thrombectomy for LVO.

1365. Clinical and Financial Implication of Dalbavancin Utilization on Length of Stay Avoidance in Acute Bacterial Skin and Skin Structure Infection

Background Our institution admits 650 patients annually for acute bacterial skin and skin structure infection (ABSSSI). These patients may require intravenous antibiotics, potentially complicated by social factors and loss to follow up. Dalbavancin is a long-acting lipoglycopeptide given as a single dose regimen for ABSSSI. A previous review conducted at our institution identified 117 potential avoidable hospital days over 4 months with outpatient dalbavancin use. The objective of this prospective study was to evaluate the clinical and financial impact of avoided admissions with outpatient dalbavancin use. Methods The Institutional Review Board approved this single-site, prospective study. All patients who presented to the emergency department (ED) with ABSSSI from December 15, 2020 to April 15, 2021 were included in the study. Dalbavancin eligibility criteria were given to providers. Eligible patients were given a single dose of dalbavancin and then discharged. The primary outcome was the difference between percentage of avoidable admissions from the ED with dalbavancin use in the retrospective cohort and prospective cohort. The secondary outcomes were estimated length of stay avoidance, percentage of treatment success without ED re-visit within 30 days, estimated hospital cost avoidance and drug cost reimbursement. The primary outcome was assessed using the Chi-square test. Descriptive statistics were used for the secondary outcomes. Results Fourteen patients received dalbavancin and avoided hospital admissions. The percentages of admissions avoided in the retrospective and prospective cohorts were 16.02% and 6.67%, respectively (Figure 1). A difference of 9.35% was found to be statistically significant (p=0.01). The total estimated length of stay avoidance was 50 days. No patients re-visited the ED within 30 days with treatment failure. The total estimated hospital cost avoidance was &148,852 (Table 1). The net reimbursement for dalbavancin over drug cost was &5,100 (Table 2). Conclusion Dalbavancin use decreased avoidable admissions. At our institution, annual hospital cost savings can reach &1,015,794 if dalbavancin was utlilized to all eligible patients. Disclosures All Authors: No reported disclosures