Inpatient Costs Research Articles

Examining the hospital costs of children born into relative deprivation in England

ObjectiveTo examine the association between being born into relative deprivation and hospital costs during childhood.DesignRetrospective cohort study.MethodsWe created a birth cohort using Hospital Episode Statistics for children born in NHS...

Emergency Service Response Time Performance Analysis in the Hospitals with Level Two Health Facilities: Comparative Study

The Emergency Unit (ER) is a part of the hospital that provides rapid treatment for patients according to the severity of their condition. Response time is the speed of the medical team in the ER in treating patients, starting from the moment the patient arrives until medical action is given. Fast and precise response time can reduce the complications that can arise and the patient's cost burden. The number of patients and the number of nurses that are not comparable can affect the response time of nurses. Research observing and comparing response times is still very limited. This study aims to determine the difference in service response time in the ER in two hospitals with second-level health facilities. This type of research is quantitative using a descriptive comparative approach. The research method uses observation and questionnaire methods. Data collection directly using the stopwhatt tool. Sampling was taken using the Accidental sampling technique. Data analysis used the difference between two means test with Mann-Whitney. Observations were carried out on nurses in the emergency room totaling 52 observations in each hospital for three months. The results of the analysis show a value of P = 0.688, where this probability value is more than 0.05, so the hypothesis fails to be rejected, so it can be concluded that statistically there is no significant difference in the Response Time of nurses in the two Emergency Units. Nurses must provide a response time according to the regulations set by the Ministry of Health, namely less than five minutes.

Outcomes of ST-Elevation Myocardial Infarction in Patients With Opioid Dependence: A National Inpatient Sample Study.

ST-segment elevation myocardial infarction (STEMI) is a critical condition characterized by the sudden obstruction of one or more coronary arteries, resulting in diminished blood flow to the heart muscle. This acute ischemic event demands swift and precise intervention to minimize myocardial damage and preserve cardiac function. Opioids, a class of potent analgesic medications, are frequently utilized in the management of STEMI-related chest pain. Despite their efficacy in alleviating discomfort, their use in this context warrants careful consideration due to potential adverse effects and interactions. Methods: In this large nationwide retrospective observational study, we evaluated the effect of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Data was collected for 2019 from various hospitals across the United States using the National Inpatient Sample (NIS) through the Healthcare Cost and Utilization Project (HCUP). Using the International Classification of Diseases-10 codes (ICD-10), we identified a primary diagnosis of STEMI in patients over the age of 18, as well as a secondary diagnosis of opioid dependence. Complex samples and multivariable logistic and linear regression models were used to determine the association of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Of the patients who fit our criteria, we identified other comorbidities and diagnoses associated with them as potential confounders including drug abuse, hypertension, diabetes, alcohol use, obesity, peripheral vascular disease, and chronic lung disease. Other confounders thatwere adjusted for include race, Charlson Comorbidity index, median household income,insurance, hospital region in the US, hospital bed size, and teaching status of the hospital. Results: A total of 661,990 patients presented to a hospital with a primary diagnosis of STEMI in 2019. The majority of the patients were malewith a mean age of 62.5+/-3.4 and were Caucasian American. Patients who were opioid dependent were found to be on average younger, earned less than the 25th percentile household income, had a higher history of illicit drug and alcohol use, and had Medicaid. They were also found to have higher rates of chronic lung disease at 39.2%, compared to 21.4.% in patients who were not opioid-dependent. Patients who were not opioid dependent were found to have higher rates of hypertension and type 2 diabetes mellitus. Inpatient mortality and cost of hospitalization in STEMI patients with opioid dependence were not statistically different compared to those who were not opioid dependent. However, STEMI patients who were opioid dependent did have an associated longer length of hospitalization. Conclusion: Opioid use for pain relief in acute coronary syndrome, particularly STEMI, is a mainstay of treatment. Our retrospective cohort dived into assessing the relationship between opioid dependence on its effect on inpatient mortality, length of stay, and cost of hospitalization in STEMI patients. Our study showed that opioid dependence has no significant impact on inpatient mortality. However, it was associated with a longer length of hospital stay in STEMI patients. Further studies may be warranted into the effects of opioid dependence on the length of hospitalization in STEMI patients. .

The cost of total hip arthroplasty: compare the hospitalization costs of national centralized procurement and national volume-based procurement.

With the increasing demand for joint replacement surgery in China, the government has successively issued the policies of national centralized procurement (NCP) and national volume-based procurement (NVBP) of artificial joints. The purpose of this study is to evaluate the impact of NCP and NVBP policies on hospitalization cost, rehospitalization and reoperation rate of total hip arthroplasty (THA). In total, 347 patients who underwent THA from January 2019 to September 2022 were retrospectively analyzed. According to the implementation of NCP and NVBP, patients were divided into three groups: control group (n = 147), NCP group (n = 130), and NVBP group (n = 70). Patient-level data on the total hospitalization costs, rehospitalization rate, THA reoperation rate and inpatient component costs were collected before and after the implementation of the policies and Consumer Price Index was used to standardize the cost. After the implementation of NCP and NVBP, the total cost of hospitalization decreased by $817.41 and $3950.60 (p < 0.01), respectively. The implantation costs decreased from $5264.29 to $4185.53 and then rapidly to $1143.49 (p < 0.01), contributing to increased total cost savings. However, the cost of surgery and rehabilitation increased after NCP and NVBP implementation (p < 0.01). The proportion of implants decreased from 66.76 to 59.22% and then to 29.07%, whereas that of drugs increased from 7.98 to 10.11% and then to 12.06%. The proportion of operating expenses rose from 4.86 to 8.01% and then to 18.47%. Univariate linear regression analysis showed that hospital stay, NCP and NVBP were correlated with total hospitalization cost (p < 0.01). Multivariate analysis showed that hospital stay, NCP and NVBP were independent predictors of total hospitalization cost (p < 0.01). In this study, hospital stay, NCP, and NVBP were independent predictors of total inpatient costs. After the implementation of NVBP policy, the cost of implants and hospitalization has decreased significantly, and the technical labor value of medical staff has increased, but a multifaceted method is still needed to solve the problem of increasing costs of other consumables. Limitations of the study suggest the need for further and more comprehensive evaluation in the future.

Evaluation of inpatient and emergency department healthcare resource utilization and costs pre- and post-nusinersen for the treatment of spinal muscular atrophy using United States claims.

Aim: Nusinersen, administered by intrathecal injection at a dose of 12mg, is indicated across all ages for the treatment of spinal muscular atrophy (SMA). Evidence on real-world healthcare resource use (HRU) and costs among patients taking nusinersen remains limited. This study aimed to evaluate real-world HRU and costs associated with nusinersen use through US claims databases. Patients & methods: Using the Merative™ MarketScan® Research Databases, patients with SMA receiving nusinersen were identified from commercial (January 2017 to June 2020) and Medicaid claims (January 2017 to December 2019). Those likely to have complete information on the date of nusinersen initiation and continuous enrollment 12months pre- and post-index (first record of nusinersen treatment) were retained. Number and costs (US$ 2020) of inpatient admissions and emergency department (ED) visits, unrelated to nusinersen administration, were evaluated for 12months pre- and post-nusinersen initiation and stratified by age: pediatric (<18years) and adult (≥18years). Results: Overall, 103 individuals treated with nusinersen were retained: 59 were pediatric (mean age [range]: 9 [1-17] years), and 44 were adults (30 [18-63] years). Inpatient admissions decreased by 41% for pediatrics and 67% for adults in the 12months post-treatment versus the 12months pre-treatment. Average inpatient admission costs per patient for the pediatric cohort decreased by 63% ($22,903 vs $8466) and by 79% ($13,997 vs $2899) for the adult cohort when comparing the 12months pre-index with the 12months post-index period. Total ED visits and ED visit costs decreased by 8% and 35%, respectively, for the overall cohort over the 12-month period pre- and post-index. Conclusion: Using US claims databases, nusinersen treatment in pediatric and adult patients was associated with reductions in HRU and costs over a 12-month period post-treatment initiation relative to the pre-treatment period.

Healthcare Use and Costs in Children Receiving Home Mechanical Ventilation in Ontario: A 14-Year Cohort Study.

Rationale: Home mechanical ventilation (HMV) is an advanced medical therapy offered to children with medical complexity. Despite the growing pediatric HMV population in North America, there are limited studies describing healthcare use and predictors of highest costs using robust health administrative data. Objectives: To describe patterns of healthcare use and costs in children receiving HMV over a 14-year period in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study (April 1, 2003, to March 31, 2017) of children aged 0-18 years receiving HMV via invasive mechanical ventilation or noninvasive ventilation. Paired t tests compared healthcare system use and costs 2 years before and 2 years after HMV approval. We developed linear models to analyze variables associated with children in the top quartile of health service use and costs. Results: We identified 835 children receiving HMV. In the 2 years after HMV approval compared with the 2 years prior, children had decreased hospitalization days (median, 9 [interquartile range, 3-30] vs. 29 [6-99]; P < 0.0001) and intensive care unit admission days (6.6 [1.9-18.0] vs. 17.1 [3.3-70.9]; P < 0.0001) but had increased homecare service approvals (195 [24-522] vs. 40 [12-225]; P < 0.0001) and outpatient pulmonology visits (3 [1-4] vs. 2 [1-3]; P < 0.0001). Total healthcare costs were higher in the 2 years after HMV approval (mean, CAD$164,892 [standard deviation, CAD$214,187] vs. CAD$128,941 [CAD$194,199]; P < 0.0001). However, all-cause hospital admission costs were reduced (CAD$66,546 [CAD$142,401] vs. CAD$81,578 [CAD$164,672]; P < 0.0001). The highest total 2-year costs were associated with invasive mechanical ventilation (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.24-5.31; reference noninvasive ventilation), number of medical devices at home (OR, 1.63; 95% CI, 1.35-1.96; reference no technology), and increased healthcare costs in the year before HMV initiation (OR, 2.23; 95% CI, 1.84-2.69). Conclusions: Children progressing to the need for HMV represent a worsening in their respiratory status that will undoubtedly increase healthcare use and costs. We found that the initiation of HMV in these children can reduce inpatient healthcare use and costs but can still increase overall healthcare expenditures, especially in the outpatient setting.

1152 Soft Tissue Infections of the Hand – Reducing Inpatient Cost and Duration of Stay in a London Plastic Surgery Department

Abstract Introduction Soft tissue infections of the upper limb referred to plastic surgery units often require hospital admission for intravenous antibiotics, irrespective of surgical intervention. Aim We explored approaches to reducing the cost and duration of inpatient admission for antibiotic treatment for soft tissue infections. Method We sampled data over a two-month period in 2023 to explore the number, type, and severity of soft tissue infections of the upper limb seen in London Plastic Surgery department. Results 35 patients with soft tissue infections of the upper limb were included. We found no correlation between age; white cell counts or c-reactive protein levels on day of presentation with duration of inpatient stay. Our studies showed that 78% of patients were discharged within 72 hours of admission or procedure, with a greater number of inpatient bed-days for patients receiving intravenous antibiotics without surgery, compared to patients receiving antibiotics and discharge within 3 days of receiving surgical intervention (36 days vs 25 days). 84% of patients were not located within post-codes accessible to existing outpatient antibiotic therapy (OPAT) services. By extending outpatient antibiotic cover for these patients, we projected a total 568 bed-day saving through 202 bed days annual avoidable inpatient bed-stay savings (3+ days, non-OPAT post-codes) and 366 bed days for additional annual avoidable short inpatient bed-stay savings (≤3 days admission, all post-codes), with projected annual cost savings of £319,558. Conclusions Our study projects a possible reduction in inpatient cost and duration of stay through extended OPAT cover in patients requiring intravenous antibiotics for soft-tissue infections of the upper limb.

Implementation, intervention, and downstream costs for implementation of a multidisciplinary complex pain clinic in the Veterans Health Administration.

To determine the budget impact of implementing multidisciplinary complex pain clinics (MCPCs) for Veterans Health Administration (VA) patients living with complex chronic pain and substance use disorder comorbidities who are on risky opioid regimens. We measured implementation costs for three MCPCs over 2 years using micro-costing methods. Intervention and downstream costs were obtained from the VA Managerial Cost Accounting System from 2 years prior to 2 years after opening of MCPCs. Staff at the three VA sites implementing MCPCs were supported by Implementation Facilitation. The intervention cohort was patients at MCPC sites who received treatment based on their history of chronic pain and risky opioid use. Intervention costs and downstream costs were estimated with a quasi-experimental study design using a propensity score-weighted difference-in-difference approach. The healthcare utilization costs of treated patients were compared with a control group having clinically similar characteristics and undergoing the standard route of care at neighboring VA medical centers. Cancer and hospice patients were excluded. Activity-based costing data acquired from MCPC sites were used to estimate implementation costs. Intervention and downstream costs were extracted from VA administrative data. Average Implementation Facilitation costs ranged from $380 to $640 per month for each site. Upon opening of three MCPCs, average intervention costs per patient were significantly higher than the control group at two intervention sites. Downstream costs were significantly higher at only one of three intervention sites. Site-level differences were due to variation in inpatient costs, with some confounding likely due to the COVID-19 pandemic. This evidence suggests that necessary start-up investments are required to initiate MCPCs, with allocations of funds needed for implementation, intervention, and downstream costs. Incorporating implementation, intervention, and downstream costs in this evaluation provides a thorough budget impact analysis, which decision-makers may use when considering whether to expand effective programming.

Resource Utilization and Costs Associated With Cardiogenic Shock Complicating Myocardial Infarction: A Population-Based Cohort Study

BackgroundCardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost. ObjectivesThe purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada. MethodsThis was a retrospective cohort study of adult patients with AMI-CS from April 2009 to March 2019. One-year costs following index admission were reported at an individual level. We used generalized linear models to identify factors associated with increased cost. We stratified patients by revascularization strategy to compare cost in each group and examined total cost at a patient level per individual fiscal year. ResultsWe included 9,789 consecutive patients with AMI-CS across 135 centers in Ontario (mean age 70.5 years; 67.7% male). Mortality in-hospital was 30.2%, and mortality at 2 years was 45.9%. The median inpatient cost per patient was $23,912 (IQR: $12,234-$41,833) with a median total 1-year cost of $37,913 (IQR: $20,113-$66,582). The median 1-year cost was $17,730 (IQR: $9,323-$38,379) for those who died in hospital, and $45,713 (IQR: $29,688-$77,683) for those surviving to discharge, with $12,719 (IQR: $4,262-$35,275) occurring after discharge. Patients who received coronary artery bypass grafting incurred the highest cost among revascularization groups. No significant differences were observed in cost per fiscal year from 2009 to 2019. ConclusionsAMI-CS is associated with significant health care costs, both during the index hospitalization and following discharge. To optimize cost-effectiveness, future therapies should aim to reduce disability in addition to improving mortality.

Health Care Utilization and Costs Associated With Empagliflozin in Older Adults With Type 2 Diabetes.

We compared health care resource utilization (HCRU) and costs for inpatient and outpatient services and dispensed medications in older adults with type 2 diabetes initiating empagliflozin versus dipeptidyl peptidase 4 inhibitors (DPP-4is). The study population included U.S. Medicare fee-for-service beneficiaries with diabetes (age ≥65 years) initiating empagliflozin or DPP-4is (August 2014 to September 2018). We estimated rate ratios (RRs) for HCRU outcomes using zero-inflated negative binomial regression and per-member per-year (PMPY) cost differences using generalized linear model with gamma distributions, overall and stratified by baseline cardiovascular disease (CVD), after adjusting for 143 baseline covariates using 1:1 propensity score matching. We identified 23,335 matched pairs (mean age 72 years, 51% with baseline CVD). HCRU rates were lower in empagliflozin versus DPP-4i initiators (number of inpatient days, RR 0.89 [95% CI 0.82, 0.97]; number of emergency department [ED] visits, 0.86 [0.82, 0.91]; number of hospitalizations, 0.86 [0.79, 0.93]; number of office visits, 0.96 [0.95, 0.98]). Inpatient cost (-$713 PMPY [95% CI -847, -579), outpatient cost (-$198 PMPY[-272, -124]), and total cost of care (-$1,109 PMPY [-1,478, -739]) were lower for empagliflozin versus DPP-4is, although diabetes medication cost was higher in empagliflozin initiators ($454 PMPY [95% CI 284, 567]). In the CVD subgroup, total cost was lower for empagliflozin initiators (-$2,005 PMPY [-2,451, -1,337]), while the difference was attenuated in the non-CVD subgroup (-$296 PMPY[-740, 148]). Among older adults with diabetes, empagliflozin was associated with a lower number of inpatient days, hospitalizations, ED visits, and office visits and with lower costs of care compared with DPP-4is, especially in those with history of CVD.

Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may suffer delays in appropriate management and adverse outcomes. We examined racial differences in the outcomes for SCAD patients undergoing PPCI for STEMI. Records of patients ≥18 years old who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of SCAD-STEMI patients undergoing PPCI was 4945, constituting 25% non-White patients. Non-White patients were younger (56 vs. 60.7 years, p<0.001), had a higher prevalence of diabetes, acute renal failure, and obesity, and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs. 8.4%, p=0.74) and hospitalization costs ($34213 vs. $31858, p=0.27) were similar for non-White and White patients, and adjusted analysis did not show any association between patients’ race and inpatient mortality (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.32-1.13; p=0.11) or hospitalization costs (β: 215; 95% CI: -4193 to 4623; p>0.90). Similarly, there was no association between patients’ race and LOS (incident rate ratio: 1.20; 95% CI: 1.00-1.45; p=0.054]. Weighted multivariate analysis showed that age; clinical comorbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the Western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, length of stay, and hospitalization costs between non-White and White patients undergoing PPCI for SCAD-related STEMI.

Initiating immunoglobulin replacement therapy helps reduce severe infections and shifts healthcare resource utilization to outpatient services among US patients with inborn errors of immunity

Aims Patients with inborn errors of immunity (IEI) are predisposed to severe recurrent/chronic infections, and often require hospitalization, resulting in substantial burden to patients/healthcare systems. While immunoglobulin replacement therapies (IgRTs) are the standard first-line treatment for most forms of IEI, limited real-world data exist regarding clinical characteristics and treatment costs for patients with IEI initiating such treatment. This retrospective analysis examined infection and treatment characteristics in US patients with IEI initiating IgRT with immune globulin infusion (human), 10% (IG10%). Healthcare resource utilization (HCRU) and associated costs before and after treatment initiation were compared. Additionally, the impact of COVID-19 on infection diagnoses was evaluated. Methods Patients with IEI initiating IG10% between July 2012 and August 2019 were selected from Merative MarketScan Databases using diagnosis/prescription codes. Patients were followed 6 months before and after first IG10% claim date. Demographic and clinical characteristics were described. Treatment characteristics and HCRU before and after IG10% initiation were compared. Infection diagnoses during 2020 and 2019 (March–December) were compared. Results The study included 1,497 patients with IEI diagnoses (mean age = 43.4 years) initiating IG10%, with frequently reported comorbidities like asthma (32.1%). Following IG10% initiation, fewer severe infection diagnoses (11.6% vs 19.9%), fewer infection-related inpatient (10.8% vs 19.5%) and outpatient services (71.6% vs 79.9%), and lower infection-related total healthcare costs ($7,849 vs $13,995; p < 0.001)—driven by lower inpatient costs ($2,746 vs $9,900)—were observed than before. Fewer patients had infection diagnoses during COVID-19 (22.8%) than the prior year (31.2%). Conclusion Patients with IEI are susceptible to severe infections leading to high disease burden and treatment costs. Following IG10% initiation, we observed fewer infections, lower infection-related treatment costs, and shift in care (inpatient to outpatient) leading to significant cost savings. Among patients with IEI, 27% fewer infection diagnoses were observed during the early COVID-19 lockdown period than the prior year.

Inpatient Hospital Costs and Route of Hysterectomy for Management of Benign Uterine Disease in the 90-Day Global Billing Period.

To compare inpatient hospital costs and complication rates within the 90-day global billing period among routes of hysterectomy. The Premier Healthcare Database was used to identify patients who underwent hysterectomy between 2000 and 2020. Current Procedural Terminology codes were used to group patients based on route of hysterectomy. Comorbidities and complications were identified using International Classification of Diseases codes. Fixed, variable, and total costs for inpatient care were compared. Fixed costs consist of costs that are set for the case, such as operating room time or surgeon costs. Variable costs include disposable and reusable items that are billed additionally. Total costs equal fixed and variable costs combined. Data were analyzed using analysis of variance, t test, and χ 2 test, as appropriate. Factors independently associated with increased total costs were assessed using linear mixed effects models. Multivariate logistic regression was performed to evaluate associations between the route of surgery and complication rates. A cohort of 400,977 patients were identified and grouped by route of hysterectomy. Vaginal hysterectomy demonstrated the lowest inpatient total cost ($6,524.00 [interquartile range $4,831.60, $8,785.70]), and robotic-assisted laparoscopic hysterectomy had the highest total cost ($9,386.80 [interquartile range $6,912.40, $12,506.90]). These differences persisted with fixed and variable costs. High-volume laparoscopic and robotic surgeons (more than 50 cases per year) had a decrease in the cost difference when compared with costs of vaginal hysterectomy. Abdominal hysterectomy had a higher rate of complications relative to vaginal hysterectomy (adjusted odds ratio [aOR] 1.52, 95% CI, 1.39-1.67), whereas laparoscopic (aOR 0.85, 95% CI, 0.80-0.89) and robotic-assisted (aOR 0.92, 95% CI, 0.84-1.00) hysterectomy had lower rates of complications compared with vaginal hysterectomy. Robotic-assisted hysterectomy is associated with higher surgical costs compared with other approaches, even when accounting for surgeon volume. Complication rates are low for minimally invasive surgery, and it is unlikely that the robotic-assisted approach provides an appreciable improvement in perioperative outcomes.

Health economics study of paliperidone palmitate in the treatment of schizophrenia: a 12-month cohort study

BackgroundTo analyze the economic benefits of paliperidone palmitate in the treatment of schizophrenia.MethodsWe collected 546 patients who met the diagnostic criteria for schizophrenia according to the 《International Statistical Classification of Diseases and Related Health Problems,10th》(ICD-10). We gathered general population data such as gender, age, marital status, and education level, then initiated treatment with paliperidone palmitate. Then Follow-up evaluations were conducted at 1, 3, 6, 9, and 12 months after the start of treatment to assess clinical efficacy, adverse reactions, and injection doses. We also collected information on the economic burden before and after 12 months of treatment, as well as the number of outpatient visits and hospitalizations in the past year to analyze economic benefits.ResultsThe baseline patients totaled 546, with 239 still receiving treatment with paliperidone palmitate 12 months later. After 12 months of treatment, the number of outpatient visits per year increased compared to before (4 (2,10) vs. 12 (4,12), Z=-5.949, P < 0.001), while the number of hospitalizations decreased (1 (1,3) vs. 1 (1,2), Z = 5.625, P < 0.001). The inpatient costs in the direct medical expenses of patients after 12 months of treatment decreased compared to before (5000(2000,12000) vs. 3000 (1000,8050), P < 0.05), while there was no significant change in outpatient expenses and direct non-medical expenses (transportation, accommodation, meal, and family accompanying expenses, etc.) (P > 0.05); the indirect costs of patients after 12 months of treatment (lost productivity costs for patients and families, economic costs due to destructive behavior, costs of seeking non-medical assistance) decreased compared to before (300(150,600) vs. 150(100,200), P < 0.05).ConclusionPalmatine palmitate reduces the number of hospitalizations for patients, as well as their direct and indirect economic burdens, and has good economic benefits.

Leukocyte- and Platelet-Rich Fibrin versus Commercially Available Fibrin Sealants in Elective Cranial Surgery: A Cost-Minimization Analysis

BackgroundPrevious findings from a clinical trial demonstrated non-inferiority of Leukocyte- and platelet-rich fibrin (L-PRF) compared to commercially available fibrin sealants in preventing postoperative cerebrospinal fluid (CSF) leakage, necessitating intervention. This cost-effectiveness evaluation aims to assess the value-for-money of both techniques for dural closure in supratentorial and infratentorial surgeries. MethodsCost-effectiveness was estimated from a healthcare payer’s perspective alongside a randomized clinical trial comprising 328 patients. The analysis focused on clinical and health-related quality of life (HRQOL) outcomes, as well as direct medical costs including inpatient costs, imaging and laboratory costs, and outpatient follow up costs up to twelve weeks after surgery. ResultsClinical and HRQOL data showed no significant differences between L-PRF (EQ5D 0.75 ± 0.25, SF-36 63.93% ± 20.42) and control (EQ5D 0.72 ± 0.22, SF-36 60.93% ± 20.78) groups. Pharmaceutical expenses during initial hospitalization were significantly lower in the L-PRF group (€190.4, IQR 149.9) than in the control group (€394.4, IQR 364.3), while other cost categories did not show any significant differences, resulting in an average cost advantage of €204 per patient favoring L-PRF. ConclusionThis study demonstrates L-PRF as a cost-effective alternative for commercially available fibrin sealants in dural closure. Implementing L-PRF can lead to substantial cost savings, particularly considering the frequency of these procedures.

Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review.

Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.

The effect of the 2009 cancer coverage expansion policy in Korea

This study focuses on the effect of coverage expansion policy on medical expenditures at each initial medical expenditure level. More specifically, how each structural change, such as the enforcement of coverage expansion policy and other observable factors, influences the spending on medical care using the relatively recently developed decomposition technique was investigated in the study. The results showed that those at the lowest or highest medical cost level benefited most from the policy change. The observable variables seemed to affect the overall differences in the cancer inpatient cost for those at the middle medical cost level, and the structural changes seemed to account for the overall change in the cancer inpatient cost for those at the lowest or the highest medical cost level. The findings of this study offer an explanation for why the coverage expansion policy could not affect the equity in health utilization and financial burden reported in previous literature.

Impact of Primary Letermovir Prophylaxis Versus Preemptive Antiviral Therapy for Cytomegalovirus on Economic and Clinical Outcomes after Hematopoietic Cell Transplantation

Preemptive therapy (PET) historically has been the primary strategy to reduce early-onset cytomegalovirus (CMV) reactivation after allogeneic hematopoietic cell transplantation (HCT) but is associated with antiviral-associated toxicities and increases in healthcare resource utilization and cost. Despite its high cost, letermovir (LTV) prophylaxis has largely supplanted PET due to its effectiveness and tolerability. Direct comparisons between LTV and PET approaches on economic and clinical outcomes after allogeneic HCT remain limited. Objective: To compare total cost of care (inpatient and outpatient) between LTV prophylaxis and PET through day+180 after allogeneic HCT. Adult allogeneic CMV seropositive (R+) HCT recipients who initiated LTV <30 days after HCT between 01/01/18 and 12/31/18 were matched 1:1 to allogeneic CMV R+ HCT recipients between 01/01/15 and 12/31/17 (PET cohort). Patients were grouped into high-risk (HR) or standard-risk (SR) for CMV to compare the LTV and PET cohorts. Direct costs for each patient's index HCT admission and all subsequent inpatient and outpatient care through day+180 after HCT were determined and converted into 2021 US dollars and then to Medicare proportional dollars (MPD). A secondary analysis using 2019 average wholesale price was conducted to specifically evaluate anti-CMV medication costs. There were a total of 176 patients with 54 HR CMV pairs and 34 SR CMV pairs. No differences in survival between LTV and PET for both HR and SR CMV groups were observed. The rate of clinically significant CMV infection decreased for both HR CMV (11/54, 20.4% versus 38/54, 70.4%, P < .001) and SR CMV (1/34, 2.9% versus 12/34, 35.3%, P < .001) patients who were given LTV prophylaxis with corresponding reductions in val(ganciclovir) and foscarnet (HR CMV only) use. Among HR CMV patients, LTV prophylaxis was associated with reductions in CMV-related readmissions (3/54, 5.6% versus 18/54, 33.3%, P < .001) and outpatient visits within the first 100 days after HCT (20 versus 25, P = .002), and a decreased median total cost of care ($36,018 versus $75,525, P < .001) in MPD was observed. For SR CMV patients on LTV, a significant reduction in the median inpatient cost ($15,668 versus $27,818, P < .001) was found, but this finding was offset by a higher median outpatient cost ($26,145 versus $20,307, P = .030) that was not CMV-driven. LTV prophylaxis is highly effective in reducing clinically significant CMV reactivations for both HR and SR HCT recipients. In this study, LTV prophylaxis was associated with a decreased total cost of care for HR CMV patients through day+180. Specifically, reductions in CMV-related readmissions, exposure to CMV-directed antiviral agents, and outpatient visits in the first 100 days after HCT were observed. SR CMV patients receiving LTV prophylaxis benefited by having a reduced inpatient cost of care due to lowered room and pharmacy costs.

Real-world cost of disease progression (PD) after frontline (1L) R-CHOP in diffuse large B-cell lymphoma (DLBCL): An analysis of a large US claims database.

e19036 Background: Previous studies on the cost of PD in DLBCL do not reflect evolving standards of care and contain limited data on novel therapies in the relapsed/refractory setting. Here, we evaluated the cost of DLBCL PD after 1L therapy using recently available data from a US healthcare database of largely commercial health plan claims. Methods: Using previously published methods (Burke, et al. 2023), this retrospective cohort study analyzed data from IQVIA PharMetrics Plus. Patients (pts) with DLBCL receiving 1L therapy with R-CHOP between October 2016 and March 2021 were included. Index date was defined as a ≥60-day gap in treatment or initiation of new agents. Pts who received non-R-CHOP therapy after 1L were assigned to the ‘PD cohort’ and those not receiving second-line (2L) treatment for ≥2 years to the ‘no PD’ cohort. All pts had continuous enrollment in medical and pharmacy benefits from R-CHOP initiation to ≥2 years post index date, allowing time for post-1L relapse. Unadjusted all-cause healthcare costs per-patient-per-month (PPPM) and 3-year cumulative costs (2023 USD) were compared between cohorts. Generalized linear models were used to adjust for baseline characteristics including age, gender, US region, payer type, Charlson Comorbidity Index (CCI), index year, and healthcare costs 1 year before index date. Results: Overall, 824 pts were included (PD cohort, n=156; no PD cohort, n=668); mean follow-up was 41.6 months. In the overall cohort: 41% were female; and at index mean (SD) age was 58.6 (11.8) years and CCI (non-cancer comorbidity) was 2.5 (3.0). Baseline characteristics were generally similar between cohorts. In the PD cohort, 76 pts (48.7%) had multiple relapse events (3L+), 67 (42.9%) received stem-cell transplant, and 27 (17.3%) received chimeric antigen T-cell therapy (CAR-T). Adjusted mean PPPM cost was higher among the PD than no PD cohort ($11,432 vs $1,698, respectively; p&lt;0.001). A major cost driver was inpatient cost (40.1% and 21.6% of total cost for PD and no PD cohort, respectively). Treatments with CAR-T in the PD cohort were associated with an 18-fold increase in PPPM cost vs the no PD cohort ($29,794 vs $1,689, respectively; p&lt;0.001), and a 4-fold increase vs pts with PD who did not receive CAR-T ($7,829; p&lt;0.001). Adjusted 3-year cumulative costs were higher in the PD ($456,045) vs no PD ($60,519) cohort. Conclusions: Compared with a previous analysis on cost of PD after 1L R-CHOP in DLBCL (2010–2018; Burke, et al. 2023), this updated analysis indicates the cost is considerable, especially among pts receiving CAR-T in later lines, and is increasing, likely due to increasing utilization of novel, more expensive therapies. 1L treatments that prevent or delay relapse could thus reduce the economic burden of PD. Our findings are of use in determining the economic value of emerging 1L options that can successfully reduce the risk of relapse.

Economic impact of longer treatment duration in first-line for HR+/HER2- metastatic breast cancer: A retrospective analysis.

1072 Background: Real-world treatment duration (TD) in the first line of therapy (1LOT) has demonstrated a strong correlation with progression-free survival (PFS). Increased TD for cancer patients (pts) in earlier lines has been linked to reduced healthcare costs by mitigating the need for costly therapies in subsequent lines, but the extent to which 1LOT costs vary based on the duration pts stay on treatment in 1LOT remains largely unknown. This study investigates the relationship between the TD of endocrine therapy (ET) plus CDK4/6 inhibition (CDKi) in 1LOT (serving as a proxy for PFS) and various healthcare cost measures incurred in 1LOT among newly diagnosed pts with HR+/HER2- metastatic breast cancer (mBC). Methods: Using the IQVIA PharMetrics Plus database, we identified adult women with newly diagnosed HR+/HER2- mBC whose 1LOT within 90 days of metastatic diagnosis (met dx) was ET + CDKi between 10/01/2016 - 06/30/2022. Pts with at least 6 months of follow-up post-met dx were included. The study followed pts from ET+ CDKi initiation until a switch, discontinuation, or a gap exceeding 90 days. Baseline characteristics were assessed 12 months before met dx. Healthcare costs (adjusted to 2022 USD) during the follow-up period were measured per patient per month (PPPM). TD was categorized based on percentile (p) distribution into six groups (&lt;10p; ≥10p to &lt;25p; ≥25p to &lt;50p; ≥50p to &lt;75p; ≥75p to &lt;90p; and ≥90p). Cost measures included total, inpatient (inp), outpatient (outp), ER, and pharmacy (rx) costs. Generalized linear and two-part models examined the relationship between various cost measures and TD, adjusting for age, region, payer type, and Elixhauser comorbidity index (ECI). Results: The study included 1,536 pts receiving ET+ CDKi in 1LOT, with a median age of 59. The median ET + CDKi TD in 1LOT was 23.7 months. PPPM costs were $18,716; $1,044; $2,899; $63; and $14,711 for total, inp, outp, ER, and rx services, respectively. Models results indicate lower PPPM total, inp, outp and ER costs as TD increases (Table). PPPM costs were higher for the bottom 10th p (shortest TD group) compared to the top 10th p (longest TD group)(difference $6,411; $2,735; $3,297; and $205 higher for total, inp, outp, and ER visits respectively). PPPM rx costs did not vary with TD. Conclusions: Real-world TD of ET+ CDKi closely aligns with PFS reported in ET + CDKi trials, further demonstrating a strong correlation with PFS. Prolonging TD in 1LOT yields significant cost savings, primarily driven by reductions in inp, outp, and ER costs. The results underscore the need for ongoing optimization of pts selection for 1LOT for HR+ mBC. The study findings also suggest that the economic evaluation of investigated treatments should take into account treatment duration. [Table: see text]