Hospitalization costs for nausea and vomiting: A savings opportunity.

Abstract

155 Background: Nausea and vomiting (NV) are tracked by CMS as 2 of 10 top drivers of potentially avoidable hospital admissions for patients with cancer. These admissions pose a savings opportunity, yet limited literature exists on the costs of chemotherapy-induced NV (CINV). Burke’s 2010 assessment of 19,139 patients from 2004-2007 found CINV hospitalizations cost $7,448 and comprised the majority of overall CINV events and costs vs ambulatory events. Rashid (2016) evaluated 1,682 patients with metastatic breast cancer from 2007-2011 and found CINV admissions cost $10,074 in 2013 US dollars. Using data from the US Agency for Healthcare Research and Quality ’s Healthcare Cost and Utilization Project website (HCUPnet), and after applying adjustment factors from recent literature, we evaluated the cost of NV hospitalizations. Methods: Data on US hospital discharges for NV (based on primary discharge diagnosis) were obtained for 2014 from HCUPnet. Charges were adjusted using Smith’s (2015) model showing commercial insurers paid 48.7% of their hospital charges. They were further modified to include professional fees equaling 26.4% of facilities paid amounts, as reported by Peterson (2015). The CPI-Medical rate was used to adjust costs to 2016 dollars. A US payer perspective was used. The proportion of total NV discharges due to CINV is not known; it is also unknown whether charges for CINV differ from those for NV overall. Results: HCUPnet reported 37,730 hospital discharges for NV, with mean charges of $23,603 per event. The mean payment to hospitals, after adjustment to reflect amounts insurers actually paid, was estimated at $11,232 per event. Adding physicians’ professional fees incurred in the hospital setting yet normally charged separately yielded a total hospitalization cost of $14,197 ($15,120 in 2016 US dollars). Conclusions: Hospitalization for NV is common and costly; adjusted paid amounts averaged > $15,000 per discharge, a level consistent with the CINV literature. This economic impact, in addition to the consequences for patients’ quality of life, suggests the need for continued advances in preventing CINV and optimizing compliance with national antiemetic guidelines, particularly for chemotherapy with high emetogenic potential.