Average Patient Cost Research Articles

The Cost of Routine Follow-Up in Total Joint Arthroplasty and the Influence of These Visits on Treatment Plans

Many physicians recommend annual or biennial visits after total hip and knee arthroplasty (THA and TKA). This study sought to establish the cost of a post-operative visit to both the health care system and patient and identify if these visits altered patient management. A prospective cohort study was conducted using patients presenting for follow-up after THA or TKA from April through December 2016. All surgeries were performed by a single orthopaedic surgeon in Wichita, Kansas. All eligible subjects that met the inclusion criteria received and completed a questionnaire about the personal cost of the visit and their assessment of their function and outcome after total joint arthroplasty. The physician also completed a questionnaire that examined the cost of the visit to the health care system and whether the clinical or radiographic findings altered patient management. Fifty-six patients participated with an average length of follow- up of 4.5 ± 4.1 years since surgery. The average patient cost was $135.20 ± $190.53 (range, $1.65 - $995.88), and the average visit time for the patient was 3.9 ± 2.9 hours. Eighty percent of patients reported no pain during the clinic encounter, and 11% reported loss of function. Eighty-four percent thought the visit was necessary. Physician time for each visit lasted 12.9 ± 3.7 minutes (range, 10 - 20 minutes). Only 9% of patient encounters resulted in an alteration in patient management. This occurred at an average follow-up time of 3.6 ± 1.8 years after the index procedure. The average cost of each visit to the health care system at large was $117.31 ± 60.53 (range, $93.90 - $428.28). The findings of this study advise total joint patients and orthopaedic surgeons regarding the cost of routine post-operative appointments and whether these visits alter patient management. The majority of the routine follow-up visits after THA and TKA did not result in an alteration in patient management, but added substantial cost to the health care system.

Abstract 174: Cost-Utility Analysis of Extracorporeal Cardiopulmonary Resuscitation in Patients With Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) provides cardiac and respiratory support and serves as a bridge to definitive therapy or to recovery. However, ECPR is resource intensive and evidence of clear survival benefit is lacking. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. Methods: We performed a retrospective review of ECPR patients who suffered cardiac arrest at our institution between 2012 and 2017. Charges for all medical care associated with ECPR and subsequent hospital care were recorded, including direct costs, indirect costs, operating costs and payer charges. The quality-of-life status of survivors was assessed with the Health Utilities Index Mark II. Results: ECPR was instituted in 24 patients (54% in-hospital [13 of 24]), mean age 49.8 ± 17.3 years, 71% male (17 of 24), and 58% African American (14 of 24). The mean and median duration of ECMO support was 3.2 and 2.7 days, respectively. The mean and median of total length of stay was 13.4 and 7.5 days, respectively. Survival to hospital discharge and 1-year survival were 17% (4 of 24) and 13% (3 of 23), respectively. The mean score of the Health Utilities Index Mark II at discharge for the survivors was 0.53 ± 0.23 (range, 0.32-0.84). The average operating cost for patients undergoing ECMO was $188,197 per patient. The calculated cost-utility for ECPR was $59,449/QALY gained. Conclusions: The calculated cost-utility for ECPR is within the threshold considered cost-effective in the United States (<$100,000/QALY gained). These results are comparable to the cost-effectiveness of orthotopic heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics and type of cannula, may affect the cost-utility benefit.

COSTS ASSOCIATED WITH PRESSURE WOUNDS IN THE U.S. INPATIENT HOSPITAL POPULATION

The 2008 Hospital-Acquired Conditions Initiative from CMS prohibited hospitals from receiving extra Medicare and/or Medicaid payments for hospital-acquired stage III and IV pressure ulcers and all stage I and II pressure ulcers. Previous research has estimated costs attributable to pressure ulcers with the use of multiple regression modeling, which may not adequately adjust for differences in health and disease status between patients who do and do not develop pressure ulcers. The purpose of this study was to employ propensity score matching (PSM) to estimate the incremental cost of pressure ulcers among a nationally representative inpatient population. All patients with a diagnosed pressure ulcer (N= 948,930) were identified from the 2012 National Inpatient Sample Database. Average unadjusted inpatient episode costs were $66,064 (± $967) and $35,844 (± $440) for patients with and without pressure ulcers, respectively. Using PSM, patients with pressure ulcers were matched to patients without pressure ulcers on sex, age, race/ethnicity, urban vs. rural residence, median income quartile of residential zip code, diagnosis of malnutrition, as well as the quantity of chronic conditions and diagnoses listed on the patient record. In the PSM-matched sample (N=1,896,450), the average total cost for patients with pressure ulcers was $66,779 (± $981) compared to $54,511 (± $552, p < .0001) for those without pressure ulcers, a difference of 22.5%. Health care systems that focus efforts on reducing the incidence and duration of pressure ulcers in their inpatient populations have the potential to realize significant savings, even among high-acuity patients.

Exploring direct costs of primary hip and knee arthroplasties healthcare-associated infections: A retrospective study

ABSTRACT Hip or knee arthroplasty healthcare-associated infections (HAI) are a public health problem that induces the increase of morbidity and mortality rates and poses an economic problem with significant impact on hospitals budget. The infection rate in primary hip and knee arthroplasties range between 1.5% and 2.5%, and is considered one of the main reasons for surgeries non-effectiveness. A retrospective study was carried out in S. João Hospital Center, EPE (CHSJ) to calculate HAI rate in primary hip and knee arthroplasties, and to analyse their direct costs, for a better understanding of their economic impact. Four hundred and eighty seven arthroplasties were studied and infection was noticed in 11 cases: 3 after hip and 8 after knee arthroplasties. Data collected from infected patients-related costs were compared with the average cost of non-infected patients (standard). An incidence rate of 2.17% for hip arthroplasties and 2.25% for knee arthroplasties was found. Results showed that patients with infection remained in hospital 7.45 times longer than uninfected patients and incurred hospital costs almost 3.8 times higher. This work shows how important is the quantification of additional HAI costs to allow hospital managers to weigh the cost/benefit ratio and better justify investments in HAI prevention and control programmes.

PUK16 - Reina (Retrospective Study on Italian ADPKD) Disease Management Cost Study

The aim of this study was to estimate the economic burden of autosomal dominant polycystic kidney disease (ADPKD) in Italy, analyzing direct costs according to progression stage of chronic kidney disease (CKD). The primary objective was the average annual cost per patient with ADPKD in Italy. The secondary objective was the average annual cost per patient suffering from ADPKD at CKD Stage I to CKD Stage V (not under dialysis), or receiving dialysis or at the post-transplant stage. This retrospective, observational study was carried out by gathering data through a pre-specified Case Report Form (CRF) in six Italian hospitals. Costs associated with ADPKD were estimated based on identified cost drivers (n of visits, n of hospitalization, treatment costs) and the analysis was performed using the Activity-Based Costing method. Inpatient and outpatient resource consumption was collected for each patient during the period 2012-2015. Direct costs were then calculated from the perspective of the Italian National Health Service (NHS). 191 patients were enrolled. The analysis estimated an average annual cost associated with ADPKD management of € 8,108. The average annual cost of patients under dialysis was € 28,279, followed by post-transplantation and CKD V patients (respectively € 22,793 and € 13,155), CKD IV (€ 7,413) and finally CKD III, CKD II, CKD I (respectively € 1,447.5, € 674.5, € 159.7). Costs increased with disease progression, except at the post-transplant stage. Outpatient specialist care (including dialysis) represented the highest impact on total costs, followed by pharmacological therapies and hospitalizations. The study underlined the relevant economic burden of ADPKD and its direct correlation with disease stage, suggesting the importance of slowing down disease progression vs ESRD, both for patient in terms of quality of life and the NHS budget

PIH6 - Pharmacist Involvement with Elderly Patients with Polypharmacy to Decrease Medical Service Use: Experience in Taiwan

It is expected that Taiwan will have a very large elderly population by 2025, and the prevalence of elderly patients will increase significantly. Aging-related physiologic changes, declining cognitive ability, multiple comorbidities, and drug interactions place this population at a higher risk of taking multiple medications. The aim of this research was to explore pharmacists’ involvement in patient care to decrease medical service use by elderly patients with polypharmacy. From March 1, 2016, to December 31, 2016, a total of 2240 elderly patients with polypharmacy were identified. We used the Taiwan National Health Insurance PharmaCloud System to care patients. The system enables physicians at contracted medical service providers to search patients’ medication records over the previous 3 months. Before patients visit doctors, pharmacists use the PharmaCloud System to review patients’ medications and make recommendations to physicians via the system when necessary. As a result of pharmacists’ involvement with elderly patients with polypharmacy, average patient costs decreased from 11.26% to -8.01%. The average number of physician visits decreased from 6.23% to -13.59%. Over the 10-month period of the study, pharmacists’ involvement in patient care led to a reduction in the drugs used for inadequate indications, with a total fee of NT 128,779. The results of our study showed that providing pharmacists’ care to elderly patients with polypharmacy improved their HbA1c level (<7%), lipid profile (low-density lipoprotein decreased from 97.27 to 94.25 mg/dL), and renal function (serum creatinine decreased from 2.33 to 2.24 mg/dL). These results demonstrate that pharmacists can perform pharmaceutical care and decrease medical service use and total cost. In addition, it could improve drug safety for patients, reduce medication fees, and decrease the cost of adverse drug reactions.

Impact of Guideline-Discordant Treatment on Cost and Health Care Utilization in Older Adults with Early-Stage Breast Cancer.

National Comprehensive Cancer Network (NCCN) guideline-based treatment is a marker of high-quality care. The impact of guideline discordance on cost and health care utilization is unclear. This retrospective cohort study of Medicare claims data from 2012 to 2015 included women age ≥65 with stage I-III breast cancer receiving care within the University of Alabama at Birmingham Cancer Community Network. Concordance with NCCN guidelines was assessed for treatment regimens. Costs to Medicare and health care utilization were identified from start of cancer treatment until death or available follow-up. Adjusted monthly cost and utilization rates were estimated using linear mixed effect and generalized linear models. Of 1,177 patients, 16% received guideline-discordant treatment, which was associated with nonwhite race, estrogen receptor/progesterone receptor negative, human epidermal growth receptor 2 (HER2) positive, and later-stage cancer. Discordant therapy was primarily related to reduced-intensity treatments (single-agent chemotherapy, HER2-targeted therapy without chemotherapy, bevacizumab without chemotherapy, platinum combinations without anthracyclines). In adjusted models, average monthly costs for guideline-discordant patients were $936 higher compared with concordant (95% confidence limits $611, $1,260). For guideline-discordant patients, adjusted rates of emergency department visits and hospitalizations per thousand observations were 25% higher (49.9 vs. 39.9) and 19% higher (24.0 vs. 20.1) per month than concordant patients, respectively. One in six patients with early-stage breast cancer received guideline-discordant care, predominantly related to undertreatment, which was associated with higher costs and rates of health care utilization. Additional randomized trials are needed to test lower-toxicity regimens and guide clinicians in treatment for older breast cancer patients. Previous studies lack details about types of deviations from chemotherapy guidelines that occur in older early-stage breast cancer patients. Understanding the patterns of guideline discordance and its impact on patient outcomes will be particularly important for these patients. This study found 16% received guideline-discordant care, predominantly related to reduced intensity treatment and associated with higher costs and rates of health care utilization. Increasing older adult participation in clinical trials should be a priority in order to fill the knowledge gap about how to treat older, less fit patients with breast cancer.

Re-engineering methadone—Cost-effectiveness analysis of a patient-centered approach to methadone treatment

Methadone maintenance treatment has proven effectiveness in the treatment of opioid use disorder, but significant barriers remain to treatment retention. In a randomized clinical trial, 300 newly-admitted methadone patients were randomly assigned to patient-centered methadone (PCM) v. treatment-as-usual (TAU). In PCM, participants were treated under revised program rules which permitted voluntary attendance at counseling and other changes focused on reducing involuntary discharge, and different staff roles which shifted disciplinary responsibility from the participant's counselor to the supervisor. The study found no significant differences in treatment retention, measures of opioid use, or other patient outcomes. This paper employs an activity-based costing approach to estimate the cost and cost-effectiveness of the two study conditions. We found that service use and costs were similar between PCM and TAU. Specifically, the average cost for PCM patients was $2396 compared to $2292 for standard methadone, while the average length of stay was 2 weeks longer for PCM patients. Incremental cost-effectiveness ratios (ICER) for self-reported heroin use, opioid positive urine screens, and meeting DSM-IV criteria for opioid dependence were mixed, with TAU achieving non-significantly better outcomes at lower treatment episode costs (i.e., economically dominating) for opioid positive urine screens. PCM patients reported slightly more days abstinent from heroin and fewer meet the opioid dependence criteria. While these differences are small and not statistically significant, we can still examine the cost-effectiveness implications. For days, abstinent from heroin, the ICER was $242 for one additional day of abstinence, however, there was notable uncertainty around this estimate. For opioid dependence criteria, the ICER was $1160 for a one-percentage point increase in the probability that a participant no longer met criteria for opioid dependence at follow-up. This economic study finds that patient choice concepts can be introduced into methadone treatment without significant impacts on costs or patient outcomes.

A Randomized Controlled Trial and Cost Analysis Assessing the Value of Physical Therapy for Treatment of Adhesive Capsulitis

Objectives:Adhesive capsulitis of the shoulder when diagnosed from history, physical exam, and radiographic evidence is generally treated with a six-month course of conservative therapy. Currently, no study has compared the use of corticosteroid injections and physical therapy (PT) to corticosteroid injections and supervised neglect (SN). Due to the average duration of symptoms associated with this syndrome, the cost of physical therapy to the patient and the medical system can be considerable. The purpose of this study is to compare physical therapy and supervised neglect while assessing the costs associated with therapy to perform a value analysis.Methods:After IRB approval was obtained, patients were prospectively randomized into either PT or SN study arms. Patients in both groups were offered corticosteroid injections at the time of first visit and at follow up intervals of 3, 6, and 12 months following enrollment. Patient reported outcome measures (PROMs) including the Disabilities of the Arm, Shoulder, and Hand (DASH) Score and the American Shoulder and Elbow Surgeons (ASES) Shoulder Score were collected at enrollment and at 6 weeks, 3 months, 6 months, and 12 months follow-up. Costs to patients were evaluated by interview at the time of final follow-up and included copays, cost of transportation, and opportunity cost of time missed from work. Value measures were generated per patient by dividing longitudinal improvements in PROMs by the costs associated with adhesive capsulitis management (PT vs SN). Analyses for improvement within treatment groups as well as comparisons of the two groups were performed. Power analysis indicated minimum sample size of 10 (r >.8) to reach non-inferiority significance. All analyses were calculated with STATA 14.2 (STATA SE 2015) and Microsoft Excel (Microsoft Corp).Results:A total of 26 patients were enrolled, with 12 patients randomized to PT and 14 patients randomized to SN. Six (50%) of the 12 patients enrolled in PT and 7 (50%) of the 14 enrolled in SN have achieved 12 month follow-up. The mean follow-up time of both groups was 10 months. No statistically significant differences were observed in follow-up time between the PT and SN groups. Statistically significant improvements from enrollment to follow-up were observed in both the PT and SN groups for the DASH (Tables 1.1 and 1.2). A comparison of the PROM improvements between the PT and SN groups yielded no statistically significant difference (Table 1.3). Average patient costs due to adhesive capsulitis treated in the PT group were $6,150.46 (range, $191.52-30,000.00), whereas patient costs sustained in the SN group were $45.00 (range, $30.00-75.00). Statistically significant differences were observed when comparing the cost and value of PT to SN.Conclusion:Both PT and SN treatment modalities showed significant improvements in the DASH Score at a mean follow-up of 10 months, indicating potential non-inferiority of SN compared to PT. Financial analysis of the two groups showed a significant difference in value with respect to outcome measures. The combination of primary costs (copays) and secondary costs (travel, copays and opportunity costs) diminish the clinical value of physical therapy as an ideal treatment to the patient. This study suggests the consideration of supervised neglect as a viable treatment approach for adhesive capsulitis, without unnecessary financial burden to the patient and medical system.Table 1.1Comparison of Enrollment vs. Follow-Up Means for ASES and DASH in Physical Therapy Arm (ARM 1)EnrollmentFollow-Upp-valueASES44.167 (29-57.667)88.333 (47.5-98)0.0630DASH.404 (.392-.6).067 (.025-.345)0.0277*Table 1.2Comparison of Enrollment vs. Follow-Up Means for ASES and DASH in Watchful Waiting Arm (ARM 2)EnrollmentFollow-Upp-valueASES58.583 (43.917-65.583)89.167 (85.833-99)0.0117*DASH.375 (.267-.538).033 (.009-.1)0.0173*Table 1.3Comparison of % Change in ASES and DASH between Arm 1 and Arm 2Arm 1Arm 2p-valueDifference in ASES44.167 (-9.167-69)37.833 (23.5-44.5)1.0000Difference in DASH-.346 (-.575- -.25)-.312 (-.526- -.221)0.6002All data provided in tables are structured as median (interquartile-range) unless stated otherwise.

Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain

Introduction and objectivesTo analyze the cost-effectiveness ratio and budget impact of treatment with evolocumab (PCSK9 inhibitor) for patients in secondary prevention in the Spanish National Health System. MethodsA budget impact analysis, decision tree and Markov models were designed under the public health system perspective, based on the only study with morbidity and mortality data (FOURIER). The alternatives compared were evolocumab vs statins, and dual therapy with ezetimibe in 5% of the population. The measure of effectiveness used was the number of cardiovascular events avoided. Univariate and probabilistic sensitivity analyses were performed. ResultsThe average annual cost of patients receiving evolocumab was 11 134.78€ and 393.83€ for standard treatment (statins plus ezetimibe). The incremental cost-effectiveness ratio was > 600 000 € per avoided cardiovascular event for both assessed outcomes (first: cardiovascular death, myocardial infarction, stroke, and hospitalization due to unstable angina or coronary revascularization; second: includes the first 3 events). To perform the 10-year Markov model, the average cost of standard treatment was 13 948.45€ vs 471 417.37€ with evolocumab. Treatment with evolocumab for patients with familial hypercholesterolemia would cost between 3 and 6.1 million euros, assuming a difference of 2.5 and 5.1 million euros with the standard treatment (2017). This difference would be between 204.3 and 1364.7 million euros (2021) for those with nonfamiliar hypercholesterolemia (secondary prevention). ConclusionsTreatment with evolocumab is associated with a lower frequency of cardiovascular events, but is inefficient for patients suitable to receive this drug in the Spanish National Health System.

452 Marijuana Use is Protective in Burns

Alcohol and other illicit drug use has been linked to poorer outcomes in trauma, including burn injuries. Routine admission blood and urine toxicology screens are not indicative of long-term use or dependence but may predict increased morbidity and/or mortality. Our objective was to analyze the effects of positive drug screens and alcohol levels at admission for patients admitted to a tertiary care burn center. Single-site, retrospective, non-randomized, observational cohort study. Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. Adult (≥18 years old) patients admitted with a burn injury with or without an inhalation injury between January 1, 2005 and December 31, 2015 were eligible for inclusion. Demographics, length of stay (LOS), cost, and mortality were evaluated. Three thousand two hundred ninety-nine patients were tested for drugs (amphetamine, cocaine, and marijuana) and/or alcohol. Fifty-six percent of patients tested positive for at least one substance. The most prevalent drug was marijuana at 29% of study population, followed by alcohol, cocaine, and then amphetamine. Patients who tested positive for marijuana and amphetamine were younger than those that tested positive for alcohol, cocaine, or with negative toxicology screens (35 years of age compared to 42 years of age). Patients who tested positive for marijuana had shorter ICU lengths of stay, hospital LOS, and total ventilator days compared to all other groups, including those testing negative for drugs or alcohol. The average hospital cost for patients testing positive for marijuana was $82,400 compared to $102,518 for patients testing positive for cocaine, $133,976 for amphetamine, $154,656 for alcohol and $90,583 for those with negative drug and alcohol screens. Mortality was 4% for patients with positive cocaine and amphetamine screens, as well as those testing negative for drugs and alcohol. Mortality was 8% for those positive for alcohol and 1% for patients with positive marijuana screens. In our patient cohort, marijuana use appears to be protective in acute burn admissions, despite classic teaching that illicit drug use leads to poorer outcomes. Age as well as advances in critical care and surgical management may be responsible for overcoming effects of these substances. These findings help to determine if an immune phenotype is protective in marijuana users who sustain a burn injury.

Coste-efectividad e impacto presupuestario del tratamiento con evolocumab frente a estatinas y ezetimiba para la hipercolesterolemia en España

Introduction and objectivesTo analyze the cost-effectiveness ratio and budget impact of treatment with evolocumab (PCSK9 inhibitor) for patients in secondary prevention in the Spanish National Health System. MethodsA budget impact analysis, decision tree and Markov models were designed under the public health system perspective, based on the only study with morbidity and mortality data (FOURIER). The alternatives compared were evolocumab vs statins, and dual therapy with ezetimibe in 5% of the population. The measure of effectiveness used was the number of cardiovascular events avoided. Univariate and probabilistic sensitivity analyses were performed. ResultsThe average annual cost of patients receiving evolocumab was 11 134.78€ and 393.83€ for standard treatment (statins plus ezetimibe). The incremental cost-effectiveness ratio was > 600 000 € per avoided cardiovascular event for both assessed outcomes (first: cardiovascular death, myocardial infarction, stroke, and hospitalization due to unstable angina or coronary revascularization; second: includes the first 3 events). To perform the 10-year Markov model, the average cost of standard treatment was 13948.45€ vs 471417.37€ with evolocumab. Treatment with evolocumab for patients with familial hypercholesterolemia would cost between 3 and 6.1 million euros, assuming a difference of 2.5 and 5.1 million euros with the standard treatment (2017). This difference would be between 204.3 and 1364.7 million euros (2021) for those with nonfamiliar hypercholesterolemia (secondary prevention). ConclusionsTreatment with evolocumab is associated with a lower frequency of cardiovascular events, but is inefficient for patients suitable to receive this drug in the Spanish National Health System.Full English text available from: www.revespcardiol.org/en

Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results.

Introduction: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient’s quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. Methods: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the “Minimum Basic Data Set (CMBD)” was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE) and their associated costs. Results: The average age of the patients analysed was 84.15 years (SD 6.28), with a length of stay of 8.01 days (SD 3.32), a mean preoperative stay of 43.04 h (SD 30.81), and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864) and the average cost increase in patients with adverse events was €2321 (SD: 3,164). Conclusions: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.

Factors associated with direct health care costs in schizophrenia: Results from the FACE-SZ French dataset

IntroductionThere is a lack of data on health care consumption of patients suffering from schizophrenia, as well as on the related health care costs. Factors associated with health care costs have not been widely studied, whereas knowledge on this topic would allow identifying risk factors and delineating strategies to improve patients’ health and follow-up, likely to also decrease health care costs. The aim of this study was to estimate the average direct health care cost of patients with schizophrenia in France and to identify the factors associated with this cost. Methods. The study population included patients with schizophrenia enrolled in the FondaMental Advanced Centers of Expertise for Schizophrenia cohort. We accounted for the costs directly related to the treatment of schizophrenia. They included the costs of hospitalizations (full- and part-time), psychiatric ambulatory consultations and medications. We studied three categories of factors potentially associated with direct health care costs: demographic, socioeconomic and clinical characteristics. Results. Three hundred and ninety five patients with schizophrenia were included. The mean (median) annual direct health care cost per patient amounted to €14,995 (€3,435). A lower level of functioning and being single were associated with a higher cost. A significant association between the expert center of inclusion and the direct health care cost of schizophrenia was also highlighted. Conclusion. Our results highlighted the significant cost of schizophrenia and suggest that improvement in patient care, based on well-validated targeted therapeutic interventions such as psycho-education and cognitive rehabilitation, could reduce worsening in symptom severity and therefore decrease health care costs.

Hospitalisation cost analysis of hip fracture in China: a cross-sectional, multicenter study

BackgroundHip fracture is common, with high morbidity and expense, which becomes a major health-care problem. Very few multicenter studies of the cost of care for hip fracture in China have been done. The aim of this study was to describe and analyse the hospitalisation cost associated with hip fractures, to compare the hospitalisation cost with the local income level, and to provide rational proposals for Chinese national medical insurance policy. MethodsIn this multicenter, cross-sectional study, we collected and analysed data from Chinese National Medical Data Center Database. The inclusion criteria were based on the main diagnosis of femoral neck or intertrochanteric fracture and a discharge date between Dec 30, 2013, and Dec 31, 2015. Hospitalisation costs, age, diagnosis, treating methods, hospitalisation provinces, and hospitalisation length of stay were collected and analysed using SPSS 23.0. We excluded any datasets that did not have the full complement of information listed above. The gross domestic product (GDP) per capita and average annual disposable income were obtained from National Bureau of Statistics of the People's Republic of China. The effect of various factors on the cost of hospitalisation was investigated using ANOVA analysis and multivariable linear regression analysis. The level of significance was set at p<0·05. The choropleth maps of the hospitalisation cost, GDP per capita, and average annual disposable income was made using Excel 2007 to compare the distribution characteristics. Findings27 205 cases from 73 central hospitals in 24 provinces were included in the study. The average cost of all patients was ¥53 440 (median ¥51158, SD ¥35 238), which was more than the GDP per capita in 2014 (¥46 629) and 2·65 times the average annual disposable income of 2014 (¥20 167). According to the multiple linear regression analysis, the diagnosis, treatment methods, and length of hospital stay had a statistically significant effect on hospitalisation costs. Furthermore, some age groups (0–19 years, 60–69 years) also had significant effects. The average cost of care for patients with femoral neck fractures was ¥12 284·22 less than for the care of patients with intertrochanteric fractures, with the standardised coefficient of 0·263; the average cost of hip replacement was ¥18560·65 higher than that of internal fixation, with the standardised coefficient of 0·263, which indicated a strong effect of the surgical approach to cost. The length of hospital stay was the most important factor, and the hospitalisation cost increased with increasing number of days spent at hospitals. The distribution of average hospitalisation cost of hip fracture patients varied a lot across different provinces, presenting a multicenter, radicalised distribution pattern, which did not match with the local income level. InterpretationThe regional economic and medical development is highly inconsistent, and the hospitalisation cost of hip fracture has become a great burden to many patients' families, especially those living in economically underdeveloped regions with high medical expense. However, the medical insurance now only covers the hospitalisation cost to a limited extent. Thus, we call for further enhancement of the Chinese medical insurance policy, which should be implemented according to the distribution characteristics of hospitalisation cost and local income levels. FundingChinese National Ministry of Science and Technology 973 Project (2014CB542201) and 863 project (SS2015AA020501), the National Natural Science Fund (31571235, 31571236, 31271284).

Social profile and cost analysis of deep infection following total hip replacement surgery

ObjectiveTo characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. MethodsTwenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. ResultsIn a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. ConclusionInfection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

Cost-of-illness of psoriasis - results of a German cross-sectional study.

Though psoriasis poses a substantial chronic socio-economic burden, few studies have addressed the economic impact in Germany. The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective. A cross-sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardized questionnaires of illness-related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non-parametric tests. Complete data were obtained from 1158 patients in 132 centres. Annual average costs for patients with psoriasis: total costs € 5543±€ 8044, systemic treatment costs (paid by the statutory health insurances [SHI]) € 3733±€ 7322, out-of-pocket costs € 224±€ 406, total SHI costs € 4940±€7533, direct costs € 5164±€ 7581 and indirect costs €379±€ 2087. Significant higher costs in male and significant lower costs in 65+-year-old patients were found. Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out-of-pocket and indirect costs towards systemic drug costs.

161 Direct Cost Analysis of 38 Cervical Spinal Deformity Operations Across Two Major Spinal Deformity Centers with Implications for Catastrophic Costs and 90-Day Cost Bundles

Abstract INTRODUCTION CMS has recently implemented 90-day cost bundles for joint replacement surgery, and taken steps to expand bundled payment programs. Our goal is to determine the 90-day costs associated with cervical spinal deformity cases across two major spinal deformity centers in order to guide the development of reasonable bundled payment plans. METHODS Retrospective evaluation of adults who underwent cervical deformity surgery 2013–2016 at two major spinal deformity centers (UCSF, Baylor). Inclusion criteria included adult patients with cervical kyphosis (C2-7 Cobb angle &gt;10°°) or cervical scoliosis (coronal Cobb able &gt;10°). Direct hospital costs for the index surgery and all visits within the first 90 days after surgery were determined from hospital billing data. Direct costs include surgical supplies/implants, room/care, pharmacy; they exclude indirect costs like overhead, administration, and utilities. RESULTS &gt;38 patients (25F, 13M; mean age = 60.4 ± 9.8 years) underwent fusions for cervical deformity. 29 procedures were posterior, 1 anterior, 7 anterior-posterior, and 1 posterior-anterior-posterior. Average number of levels fused was 9.3 ± 3.3. Average direct hospital cost for the 90-day period including surgery was $64,480 ± 23,816, and was similar between institutions ($62,569 versus $70,638). 4 of 38 patients (10.5%) were re-admitted within 90-days: re-admission costs constitute the majority of these patients' post-index surgery costs. 2 of 38 (5.3%) patients had catastrophic 90-day costs, greater than two standard deviations above the mean (&gt;$112,112). CONCLUSION The average 90-day direct hospital costs for patients undergoing cervical deformity surgery are $64,480. Readmissions and a greater number of operated levels contribute to higher costs; reasonable 90-day cost bundle plans must account for both of these issues. A limitation is that our analysis includes costs at our main hospital only; it does not include post-operative outpatient medications, physical therapy, rehabilitation, or admissions to outside hospitals. It is therefore imperative that further studies utilizing national databases are performed to understand the full scope of 90-day costs.

Factors and Medical Costs Associated With Fall Events in Hospitalized Patients

Patient falls are a common, adverse event in hospitals that may result in economic and care burdens on the patient and his/her family afterward. To analyze the factors that relate to falls among inpatients and to estimate the associated days of hospitalization and medical costs. The present study used a retrospective matched case-control design to analyze inpatient fall data for 2009 to 2011 from a regional teaching hospital in northern Taipei. We matched fallers and controls according to gender, age ∓ 5 years, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code. Data were analyzed using descriptive and inferential statistics. A total of 160 inpatients participated in the present study (80 fallers in the fall group and 80 nonfallers in the control group). The results revealed that fallers had more previous fall experiences and longer hospital stay than nonfallers. Multiple logistic regression analysis revealed that the risk factors that were significantly associated with inpatient falls included: no family accompaniment, use of more than 3 fall-related medications, and no intravenous catheter placement. Results further found that medical costs increased with the degree of injury. Third-degree injuries bore the highest post-fall medical costs of all of the injury-degree categories. The average medical cost for patients with third-degree injuries was 18,257 New Taiwan dollars. The findings provide a reference for hospitals to promote patient safety, to prevent the occurrence of inpatient falls, and, ultimately, to reduce fall-associated medical costs.

Long-term economic value of hypofractionated prostate radiation: Secondary analysis of a randomized trial

PurposeModerately hypofractionated intensity modulated radiation therapy (HIMRT) for prostate cancer shortens the treatment course while providing outcomes comparable with those of conventional intensity modulated radiation therapy (CIMRT). To determine the long-term economic value of HIMRT, including the costs of managing long-term radiation toxicities, a cost minimization analysis compared CIMRT with dose-escalated HIMRT using patient-level data from a randomized trial. Methods and materialsMen with localized prostate cancer were randomized to CIMRT (75.6 Gy in 42 fractions over 8.4 weeks) or HIMRT (72 Gy in 30 fractions over 6 weeks). A decision tree modeled trial probabilities of maximum late bowel and urinary toxicities using patient-level data with a median follow-up of 6 years. Costs were estimated from the healthcare perspective using the 2014 national reimbursement rates for services received. Patient-level institutional costs, adjusted to 2014 dollars, verified reimbursements. A sensitivity analysis assessed model uncertainty. ResultsThe cost for HIMRT and toxicity management was $22,957, saving $7,000 compared with CIMRT ($30,241). CIMRT was the common factor among the 5 most influential scenarios that contributed to total costs. Toxicity represented a small part (<10%) of the average total cost for patients with either grade 2-3 bowel toxicity or grade 2-3 urinary toxicity. However, toxicity management reached up to 26% of the total cost for patients with both high-grade bowel and urinary toxicities. There was no threshold at which CIMRT became the less costly regimen. Institutional costs confirmed the economic value of HIMRT ($6,000 in savings). ConclusionsHIMRT is more cost-efficient than CIMRT for treating prostate cancer, even when taking into account the costs related to late radiation toxicities. HIMRT enhances the value of prostate radiation when compared with CIMRT.