Impact of Hospital Teaching Status on Hospital Costs and Length of Stay for Heart Failure Patients with History of Hematopoietic Stem Cell Transplant: A National Inpatient Sample Analysis 2010-2014

Abstract

Background As emphasis on optimization healthcare resources and costs is increasing, several studies have suggested higher healthcare costs associated with hematopoietic stem cell transplant (HSCT). Proposed guidelines are present to prevent treatment-related long-term complications. This allows for early intervention with resultant reduction in morbidity and mortality and reduction in healthcare costs. Cardiovascular morbidity and mortality have been associated with increased healthcare cost burden for patients in HSCT. Armenian et al have reported a cumulative incidence of congestive heart failure at 5 years after HSCT of 4.8 %, increasing to 9.1 % at 15 years. The influence of hospital teaching status on average health care costs for patients with history of HSCT developing heart failure (HF) is unknown. Methods NIS is the largest publicly available all-payer inpatient care database in the United States and is sponsored by the Agency for Healthcare Research and Quality as a part of Healthcare Cost and Utilization Project. We queried the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) between 2010 and 2014 to identify all adult (>18 years of age) hospitalizations for HF with history of HSCT using ICD-9 CM diagnostic codes and stratified these hospitalizations into two groups based on teaching status of the hospital. STATA version 15.0 (College Station, TX) was used for analysis to accommodate for the complex design of survey sample data. Results We identified 2095980 admissions in teaching hospitals and 2385912 admissions in non-teaching hospitals for HF from 2010 to 2014. Amongst these 1080 total admissions with HF had underlying diagnosis of HSCT, patients admitted to teaching hospitals were younger (average age 55.95 years in teaching vs 61.97 years in non-teaching; p value=0.001). No difference was noted in other baseline characteristics like gender, race, charlson comorbidity index. Patients admitted to teaching hospitals were noted to have a higher average cost per admission ($76555 vs $32440; p value=0.005) and increased length of stay (6.06 days vs 4.23 days; p value=0.0043). Conclusion Our study found increased mean hospital charges and length of stay in heart failure patients with a history of HSCT in teaching hospitals. Previous studies have reported similar results in general population. Opportunities that target cost reduction and length of stay may be leveraged. The use of preventive guidelines, close follow up with targeted services addressing specific conditions such as congestive heart failure in patients with HSCT can help reduce health care cost burden.