Abstract
ObjectUnited States healthcare reforms are focused on curtailing rising expenditures. In neurosurgical domain, limited or no data exists identifying potential modifiable targets associated with high-hospitalization cost for cerebrovascular procedures such as extracranial-intracranial (ECIC) bypass. Our study objective was to develop a predictive model of initial cost for patients undergoing bypass surgery.MethodsIn an observational cohort study, we analyzed patients registered in the Nationwide Inpatient Sample (2002–2011) that underwent ECIC bypass. Split-sample 1:1 randomization of the study cohort was performed. Hospital cost data was modelled using ordinary least square to identity potential drivers impacting initial hospitalization cost. Subsequently, a validated clinical app for estimated hospitalization cost is proposed (https://www.neurosurgerycost.com/calc/ec-ic-by-pass).ResultsOverall, 1533 patients [mean age: 45.18 ± 19.51 years; 58% female] underwent ECIC bypass for moyamoya disease [45.1%], cerebro-occlusive disease (COD) [23% without infarction; 12% with infarction], unruptured [12%] and ruptured [4%] aneurysms. Median hospitalization cost was $37,525 (IQR: $16,225-$58,825). Common drivers impacting cost include Asian race, private payer, elective admission, hyponatremia, neurological and respiratory complications, acute renal failure, bypass for moyamoya disease, COD without infarction, medium and high volume centers, hospitals located in Midwest, Northeast, and West region, total number of diagnosis and procedures, days to bypass and post-procedural LOS. Our model was validated in an independent cohort and using 1000-bootstrapped replacement samples.ConclusionsIdentified drivers of hospital cost after ECIC bypass could potentially be used as an adjunct for creation of data driven policies, impact reimbursement criteria, aid in-hospital auditing, and in the cost containment debate.
Highlights
United States healthcare expenditure as a fraction of its Gross Domestic Product (GDP) is the highest compared to any other nation, translating to over 17 percent of its GDP in the recent years. [1, 2] In 2015 alone, official estimates suggest healthcare spending exceeded $3.2 trillion, creating a net increase of 5.8% from the preceding year, and over 23% since 2010. [2] As witnessed in previous decades, the increment in healthcare spending has consistently outpaced the annual GDP growth
Common drivers impacting cost include Asian race, private payer, elective admission, hyponatremia, neurological and respiratory complications, acute renal failure, bypass for moyamoya disease, cerebro-occlusive disease (COD) without infarction, medium and high volume centers, hospitals located in Midwest, Northeast, and West region, total number of diagnosis and procedures, days to bypass and post-procedural
Identified drivers of hospital cost after ECIC bypass could potentially be used as an adjunct for creation of data driven policies, impact reimbursement criteria, aid in-hospital auditing, and in the cost containment debate
Summary
United States healthcare expenditure as a fraction of its Gross Domestic Product (GDP) is the highest compared to any other nation, translating to over 17 percent of its GDP in the recent years. [1, 2] In 2015 alone, official estimates suggest healthcare spending exceeded $3.2 trillion, creating a net increase of 5.8% from the preceding year, and over 23% since 2010. [2] As witnessed in previous decades, the increment in healthcare spending has consistently outpaced the annual GDP growth. [2] As witnessed in previous decades, the increment in healthcare spending has consistently outpaced the annual GDP growth In this context, several initiatives directed towards cost containment are implemented to redefine value in healthcare.[3] Pertinent developments include replacement of the “fee-for-service” model with bundled payments, administrative restructuring for improved efficiency, Medicaid expansion, monitoring by accountable care organizations (ACOs), and imposing financial penalties on hospitals and providers for inadequate care as determined by readmission rates. Several initiatives directed towards cost containment are implemented to redefine value in healthcare.[3] Pertinent developments include replacement of the “fee-for-service” model with bundled payments, administrative restructuring for improved efficiency, Medicaid expansion, monitoring by accountable care organizations (ACOs), and imposing financial penalties on hospitals and providers for inadequate care as determined by readmission rates Concerning these seismic political reforms in healthcare setup, neurosurgical procedures those involving cerebral vasculature are likely to elicit attention from policy makers owing to the high risks and hospitalization costs associated with it. Limited or no literature exists on drivers of hospitalization costs for patients undergoing bypass procedure
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