Hospital Admission Costs Research Articles

Cost and Health Care Resource Utilization Differences After Spine Surgery for Bony Spine versus Primary Intradural Spine Tumors

The aim of this study was to compare complication rates, length of stay (LOS), and hospital costs after spine surgery for bony spine tumors and intradural spinal neoplasms. A retrospective cohort study was performed using the National Inpatient Sample database from 2016 to 2017. All adult inpatients who underwent surgical intervention for a primary intradural spinal tumor or primary/metastatic bony spine tumor were identified using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis/procedural coding systems. Patient demographics, comorbidities, intraoperative variables, complications, LOS, discharge disposition, and total cost of hospitalization were assessed. Backward stepwise multivariable logistic regression analyses were used to identify independent predictors of perioperative complication, extended LOS (≥75th percentile), and increased cost (≥75th percentile). A total of 9855 adult patients were included in the study; 3850 (39.1%) were identified as having a primary intradural spinal tumor and 6005 (60.9%) had a primary or metastatic bony spine tumor. Those treated for bony tumors had more comorbidities (≥3, 67.8% vs. 29.2%) and more commonly experienced ≥1 complications (29.9% vs. 7.9%). Multivariate analyses also showed those in the bony spine cohort had a higher odds of experiencing ≥1 complications (odds ratio [OR], 4.26; 95% confidence interval [CI], 3.04-5.97; P < 0.001), extended LOS (OR, 2.44; 95% CI, 1.75-3.38; P< 0.001), and increased cost (OR, 5.32; 95% CI, 3.67-7.71; P< 0.001). Relative to patients being treated for primary intradural tumors, those undergoing spine surgery for bony spine tumors experience significantly higher risk for perioperative complications, extended LOS, and increased cost of hospital admission. Further identification of patient and treatment characteristics that may optimize management of spine oncology may reduce adverse outcomes, improve patient care, and reduce health care resources.

Short-Term Associations of Ambient Fine Particulate Matter (PM2.5) with All-Cause Hospital Admissions and Total Charges in 12 Japanese Cities.

The short-term association between ambient particulate matter ≤2.5 microns in diameter (PM2.5) and hospital admissions is not fully understood. Studies of this association with hospital admission costs are also scarce, especially in entire hospitalized populations. We examined the association between ambient PM2.5 and all-cause hospital admissions, the corresponding total charges, and the total charges per patient by analyzing the hospital admission data of 2 years from 628 hospitals in 12 cities in Japan. We used generalized additive models with quasi-Poisson regression for hospital admissions and generalized additive models with log-linear regression for total charges and total charges per patient. We first estimated city-specific results and the combined results by random-effect models. A total of 2,017,750 hospital admissions were identified. A 10 µg/m3 increase in the 2 day moving average was associated with a 0.56% (95% CI: 0.14–0.99%) increase in all-cause hospital admissions and a 1.17% (95% CI: 0.44–1.90%) increase in total charges, and a 10 µg/m3 increase in the prior 2 days was associated with a 0.75% (95% CI: 0.34–1.16%) increase in total charges per patient. Short-term exposure to ambient PM2.5 was associated with increased all-cause hospital admissions, total charges, and total charges per patient.

Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study.

Background:Acute inpatient hospital admissions account for more than half of all health care costs related to diabetes. We sought to identify the most common and costly conditions leading to hospital admission among patients with diabetes compared with patients without diabetes.Methods:We used data from the General Internal Medicine Inpatient Initiative (GEMINI) study, a retrospective cohort study, of all patients admitted to a general internal medicine service at 7 Toronto hospitals between 2010 and 2015. The Canadian Institute for Health Information (CIHI) Most Responsible Diagnosis code was used to identify the 10 most frequent reasons for admission in patients with diabetes. Cost of hospital admission was estimated using the CIHI Resource Intensity Weight. Comparisons were made between patients with or without diabetes using the Pearson χ2 test for frequency and distribution-free confidence intervals (CIs) for median cost.Results:Among the 150 499 hospital admissions in our study, 41 934 (27.8%) involved patients with diabetes. Compared with patients without diabetes, hospital admissions because of soft tissue and bone infections were most frequent (2.5% v. 1.9%; prevalence ratio [PR] 1.28, 95% CI 1.19–1.37) and costly (Can$8794 v. Can$5845; cost ratio [CR] 1.50, 95% CI 1.37–1.65) among patients with diabetes. This was followed by urinary tract infections (PR 1.16, 95% CI 1.11–1.22; CR 1.23, 95% CI 1.17–1.29), stroke (PR 1.13, 95% CI 1.07–1.19; CR 1.19, 95% CI 1.14–1.25) and electrolyte disorders (PR 1.11, 95% CI 1.03–1.20; CR 1.20, 95% CI 1.08–1.34).Interpretation:Soft tissue and bone infections, urinary tract infections, stroke and electrolyte disorders are associated with a greater frequency and cost of hospital admissions in patients with diabetes than in those without diabetes. Preventive strategies focused on reducing hospital admissions secondary to these disorders may be beneficial in patients with diabetes.

Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008–2017): a retrospective multicentre study

Objective The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients’ use of resources and medical costs. Methods Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. Results Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. Conclusions The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.

Randomized Controlled Trial Evidence of Cost-Effectiveness of a Multifaceted AKI Intervention Approach

IntroductionAcute kidney injury (AKI) is associated with increased health care utilization and higher costs. The Tackling AKI study was a multicenter, pragmatic, stepped-wedge cluster randomized trial that demonstrated a reduced hospital length of stay after implementation of a multifaceted AKI intervention (e-alerts, care bundle, and an education program). We tested whether this would result in cost savings.MethodsA decision-analytic tree model from the payer perspective (National Health Service in the United Kingdom) was generated on which cost-effectiveness analyses were performed using a probabilistic sensitivity analysis, accounting only for direct medical costs. Clinical data from the Tackling AKI study were used as inputs and economic and utility data derived from relevant published literature.ResultsA total of 24,059 AKI episodes occurred during the study period, and in 18,887 admissions the patient was discharged alive. When all AKI stages were considered together, the cost per AKI admission was £5065 in the control arm and £4333 in the intervention arm, representing an incremental cost saving of £732 per admission with the intervention. Similar results were obtained when AKI stages were included as separate variables. Costs per quality-adjusted life year were £61,194 in the control group and £51,161 in the intervention group. At a willingness to pay threshold of £20,000 per quality-adjusted life year, the probability of the intervention being cost-effective compared with standard care was 90%.ConclusionAn organizational level approach to improve standards of AKI care reduces the cost of hospital admissions and is cost effective within the National Health Service in the United Kingdom.

Measuring The Impact Of Air Pollution On Health Care Costs.

Air pollution contributes to the development of numerous adverse human health outcomes. The Environmental Protection Agency's Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) tool is widely used in estimating the health care costs of air pollution and in the development of federal and state regulations and policy. Its default features consider only the costs of hospital and emergency department admissions. A more complete accounting of the chain of costs would include ambulatory and other care. In this article we use employer health insurance claims data to infer additional costs that accompany hospitalizations but are not included in BenMAP-CE. Including additional categories increases BenMAP-CE health care cost estimates by approximately 40percent for respiratory and cardiovascular patients. That is, for each dollar of health care costs captured by BenMAP-CE, a more complete accounting would include an additional 40 cents. These results suggest that because such air pollution costs are underestimated, the health care benefits associated with reducing air pollution may be much larger than previously estimated.

Tranexamic Acid in Patients With Cancer Undergoing Endoprosthetic Reconstruction: A Cost Analysis.

Tranexamic acid (TXA) decreases blood loss, perioperative transfusion rates, and cost in total hip and total knee arthroplasty. In a previous study, topical TXA decreased both perioperative blood loss and transfusions in patients undergoing resection of aggressive bone tumors and endoprosthetic reconstruction. The purpose of this study was to explore the cost effectiveness of TXA in patients undergoing resection of an aggressive bone tumor and endoprosthetic reconstruction, assessing transfusion cost, TXA administration cost, postoperative hospitalization cost, posthospital disposition, and 30-day readmissions. This study included 126 patients who underwent resection of an aggressive bone tumor and endoprosthetic resection at a single academic medical center; 61 patients in the TXA cohort and 65 patients in the non-TXA cohort. The cost of 1 unit of packed red blood cells, not including administration or complications, was estimated at our institution. The cost of hospitalization was estimated for lodging and basic care. The cost of TXA was $55 per patient. Patients were followed up for 30 days to identify hospital readmissions. Patients in the TXA cohort experienced a TXA and blood transfusion cost reduction of $155.88 per patient (P = 0.007). Proximal femur replacement patients experienced a $282.05 transfusion cost reduction (P = 0.008), whereas distal femur replacement patients only experienced a transfusion cost reduction of $32.64 (P = 0.43). An average hospital admission cost reduction of $5,072.23 per patient (P < 0.001) was associated with TXA use. Proximal femur replacement patients who received TXA experienced a hospital cost reduction of $5,728.38 (P < 0.001), whereas distal femur replacement patients experienced a reduction of $3,724.90 (P = 0.01). No differences between the cohorts were identified in discharge to home (P = 0.37) or readmissions (P = 0.77). TXA administration is cost effective in patients undergoing resection of an aggressive bone tumor and endoprosthetic reconstruction through reducing both perioperative transfusion rates and postoperative hospitalization. III-Retrospective Cohort Study.

The Epidemiological and Financial Effects of Pneumococcal Vaccination on Otitis Media Related Admissions in the United States.

To quantify the prevalence of hospital admissions, the financial impact, and the trends in surgical procedure rates for AOM and CAOM for all ages before and after 13-valent pneumococcal conjugate vaccine (PCV13) introduction. Retrospective analysis of the National Inpatient Sample (NIS) from 1998 to 2013 to determine the prevalence of AOM/CAOM related admissions and weighted frequencies of AOM/CAOM related International Classification of Diseases, ninth revision (ICD-9) hospital diagnoses. Prevalence of surgical procedures to treat CAOM, cost of admission, length of stay, and cost per day of admission were tabulated. Trend analysis of this data was performed. A total of 46 580 patients were hospitalized with AOM in the designated time period, of which 37 366 had CAOM. The prevalence of hospital admission due to AOM had the most pronounced decrease from pre-vaccine era (1998) to post-PCV13 implementation (2013) in age group 0 to 4 (32%) followed by age group 5 to 19 (7%). Age groups 20-64 and 65+ showed slight increases in prevalence. The trend in prevalence of admissions due to CAOM mirrors that of overall admissions with an 18% and 5.8% decrease in age groups 0-4 and 5-19, respectively, and a 1% increase in ages 20+. The inflation adjusted mean cost of admission did not significantly increase between 2001 and 2013. The total cost per admission was $4428 and $7546 for those with AOM and CAOM, respectively. Mastoidectomy rates increased by 17% in hospitalized children during the post-vaccine era but decreased in the elderly population. The prevalence of AOM/CAOM hospital admissions decreased from the pre-vaccine era (1998) to post-PCV13 implementation (2013) in pediatric patients. Surgical procedure utilization and cost of hospital admission for AOM/CAOM did not increase throughout the study period.

All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives.

Surgeons play a critical role in making cost-effective decisions that maintain high-quality patient outcomes, which is the current focus of the Centers for Medicare & Medicaid Services. All-polyethylene tibial (APT) components often cost less during total knee arthroplasty (TKA). The authors sought to determine the relative cost savings of APT, as well as their effect on 90-day quality outcome metrics. This was a retrospective review of primary TKAs performed at a single tertiary referral center participating in the Comprehensive Care for Joint Replacement model, by 2 surgeons, from 2015 to 2017. Patient demographic data and direct hospital costs were collected, and patients were stratified by APTs vs metal-backed components. Univariable and multivariable analyses were performed for all outcome metrics. A total of 188 primary TKAs were included (92 APT, 96 metal-backed). Patients receiving APT components were older (P<.001) and had a lower body mass index (P<.001), but there was no difference in sex or American Society of Anesthesiologists score between groups. Operative time was significantly less (mean, 13 minutes) and direct surgery costs were significantly lower for APTs (P<.001). A multivariable regression model for surgical costs demonstrated significant savings (P<.001), and total hospital cost demonstrated a 6.2% average savings with APT. There was no difference in 90-day emergency department visits or re-admissions. This study demonstrates that the use of an APT is able to significantly affect not only the surgical cost but also the total hospital admission cost while maintaining equivalent 90-day outcome metrics. Strategies like this should be considered in appropriately selected patients as the incidence of TKA continues to expand. [Orthopedics. 2021;44(1):e114-e118.].

Integrating intravenous frusemide treatment into the community for heart failure patients

Abstract Background A structured pathway was developed to allow patients to safely receive intravenous (i/v) frusemide at home. This pathway was implemented by an integrated team consisting of primary and tertiary care. This allowed the traditional acute hospital treatment to be now delivered in the community. Purpose This concept has been used on an individual case basis by a minority of acute hospitals. Previously there was no structured pathway that would allow this treatment to become a standard part of heart failure treatment by acute hospitals. The pathway would ensure that the treatment would be delivered safely to a cohort of patients who meet certain criteria. Methods A pathway was developed by a consultant cardiologist, heart failure (HF) nurses and the Community Intervention Team (CIT)/CareDoc. The Caredoc Community Intervention Team (CIT) is a nurse led professional team that provides acute nursing care to patients in the community setting. The HF nurse would identify the suitable patient for i/v frusemide as per pathway. A referral would be sent to the CIT team who would administer the frusemide at the patients home. The CIT team would take a renal profile daily, check vital signs, check symptoms of HF and check daily weight on the patient while they were receiving i/v frusemide. The bloods results would be reviewed daily by the HF nurse. The HF nurse would liaise daily with the CIT team and patient for symptoms, daily weights and vital signs. The patient would then be reviewed in the HF clinic post treatment. Results Single centre retrospective analysis was undertaken of the patients who received i/v frusemide at home over a 3 year period. 83 patients meet the inclusion criteria and received the treatment. 70 male and 13 female. Average age 78 years old. Average length of treatment 3 days. Treatment was given twice daily, average daily dose was 137 mg. Majority of treatment was 80mg bd or 60 mg bd. No failure cannulating any patient as CIT had high cannulation skills due to regular cannulation as part of workload. 3 episodes of hypokalaemia, lowest potassium was 3.1 mmols, all 3 episodes were effectively treated with oral potassium supplements. No significant acute kidney injury was noted that required change to treatment. 6 patients required heart failure associated admission to hospital, 3 had hypotension, 1 has fast A-flutter and 2 remained resistance to i/v frusemide and required inotropes. Both patient and carers reported a high satisfaction rate with the service. Conclusion National length of stay for a HF patient in Ireland is 11 days.This novel structured pathway successfully selected appropriate patients who can safely receive i/v frusemide at home. 93% avoided hospital admission.This reduces the need for acute hospital admission and significant associated costs. Patients and carers rated 95% satisfaction with service.Sustainability of the project is driven by an integration team approach. Funding Acknowledgement Type of funding source: None

Attributable risk and economic cost of hospital admissions for mental disorders due to PM2.5 in Beijing

Background Few studies have estimated the attributable risk and economic cost of mental disorders (MDs) due to particulate matters with aerodynamic diameter of less than 2.5 µm (PM2.5) exposure in Beijing.Objectives This study aims to identify the possible correlation between PM2.5 and risk of hospital admissions (HAs) for MDs in Beijing and calculate the attributable risk and economic cost.Methods A generalized additive model (GAM) with controlling for time trend, meteorological conditions, holidays and day of the week was used to estimate the associations. Stratified analyses were performed by age, gender and season. We further estimated the health and economic burden of HAs for MDs attributable to PM2.5.Results A total of 17,252 HAs for MDs were collected. A 10 µg/m3 daily increase in PM2.5 was associated with a statistically significant risk increase of 3.55% for HAs for MDs. The effects of PM2.5 exposures on HAs for MDs were more pronounced in males, elderly (≥65 years old) individuals and in cold seasons. Using WHO's air quality guidelines as the reference, 15.12% of HAs (2,609 person-times out of 17,252 person-times) and 16.19% of the related medical expenses (51.86 million CNY out of 320.3 million CNY) for MDs were attributed to PM2.5 during the study period.Conclusion PM2.5 accounts for substantial morbidity and economic burden of MDs for both the society and households, which shows environmental protections are essential to improve mental health status of the population.

Private versus public? Examining hospital use by a privately insured population in New South Wales, Australia, using data linkage.

Objective To examine hospital use characteristics of a privately insured cohort including hospital setting (public or private), declared insurance status and category of services received during hospital admission. Methods The study population consisted of 14276 people with membership of a private health insurance (PHI) fund in New South Wales, Australia. The final study cohort included 9004 people with at least one hospital admission over a 6-year period from 1 January 2010 to 31 December 2015. PHI claims data were linked with public hospital records from a Local Health District. Hospital utilisation measures include number of admissions and length of stay. Measures were categorised by hospital user group (public only, private only or both), declared insurance status (PHI or public patient), type of service and admission case weight. Results The study finds that despite having PHI, 40% of people receive services exclusively in a public hospital in the 6-year study period. Additionally, only 62% of overnight hospital admissions for the study population are claimed on PHI. There are differences in hospital utilisation for medical- and surgical-related admissions. Seventy percent of people with a medical admission receive services only in public hospitals, but a similar proportion of people (66%) receive services only in private hospitals for surgical admissions. Conclusions People with PHI make considerable use of public hospitals both as a public and a private patient. For this privately insured cohort, public hospitals are more frequently used for medical-related admissions and also for more resource-intensive admissions compared with private hospitals. What is known about the topic? There are multiple government incentives to encourage people to take out PHI policies in Australia. Although PHI is closely associated with private hospital utilisation, people with PHI can still use public hospitals as either a public patient, in which the service is fully government-funded, or as a private patient in which PHI contributes funding towards the cost of hospital admissions. What does this paper add? This study provides the first analysis of hospital utilisation of a privately insured cohort in Australia that reports on the interaction between public and private hospital use and declared insurance status, including utilisation differences based on service type. What are the implications for practitioners? Although there are financial incentives offered by the Australian Government to encourage uptake of PHI, the study findings show that people with PHI still make considerable use of public hospitals both as a public and private patient. Future policy reforms relating to the regulation of PHI in Australia should consider the nuanced differences in the way people with PHI use public and private hospitals to optimise resource allocation.

S0546 No Significant Differences in Mortality Among Stroke vs Non-Stroke Patients Undergoing Percutaneous Endoscopic Gastrostomy, National Inpatient Sample Study 2016

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a frequently performed procedure in patients with stroke. This study aimed to investigate the differences in in-hospital outcomes for stroke patients compared with non-stroke patients undergoing PEG. METHODS: In this retrospective study, the 2016 National Inpatient Sample database was analyzed by using ICD-10 Code for hospitalizations with a procedure code of PEG. Those patients were further divided into the stroke or non-stroke group based on whether they had a primary or secondary diagnosis as ischemic or hemorrhage stroke. Patients who were younger than 18 were excluded from this analysis. The primary outcome of interest was in-hospital all-cause mortality. The secondary outcomes of interest were the rate of aspiration pneumonia, length of stay, and total cost of the hospital admission. Multivariate regression was used to adjust for age, gender, race, incomes, insurance, hospital characteristics, and comorbidities. STATA 14 (College Station, TX) was used for analysis. RESULTS: A total of 27,500 patients with stroke underwent PEG in 2016, which made up 19.4% of all PEGs performed. Compared with patients without stroke, patients in the stroke group were older (69.1 vs 67.1 years, P < 0.001), more likely to be female (48.0% vs 42.9%, P < 0.001), and had a higher Charlson Comorbidity Index (4.20 vs 3.01, P < 0.001). Compared with the non-stroke group, the in-hospital all-cause mortality was not significantly different in stroke group (6.52% vs 6.74%) with an adjusted odds ratio (OR) of 0.95 [95% CI (0.83–1.08), P = 0.416]. However, stroke patients had a higher rate of aspiration pneumonia (25.64% vs 20.99%, P < 0.001), a longer length of stay (21.6 days vs 19.8 days, P < 0.001), and higher total cost of hospital admission ($61745 vs $ 53972, P < 0.001). In the subgroup analysis of stroke patients undergoing PEG, Hispanic ethnicity [adjusted odds ratio: 1.65, 95% CI: 1.14–2.38, P < 0.01] and coexisting aspiration pneumonia [adjusted odds ratio: 1.53, 95% (1.21-1.94), P < 0.001] were associated with higher mortality. CONCLUSION: Among patients undergoing PEG, stroke patients did not have a significantly different in-hospital all-cause mortality compared to non-stroke patients. However, they had a higher rate of aspiration pneumonia, a longer length of stay, and higher total cost of hospital admission.Table 1.: Basic characteristics of stroke vs. non-stroke patients undergoing PEG.Table 2.: In-hospital outcomes of stroke vs. non-stroke patients undergoing PEG.

The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology

The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology

Quantifying the direct secondary health care cost of seasonal influenza in England

BackgroundThe winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons.MethodsThe number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations.ResultsDuring the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay.ConclusionThis study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.

Increases in Actual Health Care Costs and Claims After Firearm Injury.

The incidence of firearm injury and death in the United States is increasing. Although the health care-related effect of firearm injury is estimated to be high, existing data are largely cross-sectional, do not include data on preinjury and postinjury health care visits and related costs, and use hospital charges rather than actual monetary payments. To compare actual health care costs (that is, actual monetary payments) and utilizations within the 6 months before and after an incident (index) firearm injury. Before-after study. Blue Cross Blue Shield plans of Illinois, Texas, Oklahoma, New Mexico, and Montana. Plan members continuously enrolled for at least 12 months before and after an index firearm injury sustained between 1 January 2015 and 31 December 2017. Eligible costs, out-of-pocket costs, and firearm injury-related International Classification of Diseases, Ninth or 10th Revision, codes. Total initial (emergency department [ED]) health care costs for persons with index firearm injuries who were discharged from the ED were $8158786 ($5686 per member). Total initial (hospital admission) costs for persons with index firearm injuries who required hospitalization were $41255916 ($70644 per member). Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347% (from $3984 to $17806 per member) for those discharged from the ED and 2138% (from $4118 to $92151 per member) for those who were hospitalized. The number of claims increased by 187% for patients discharged from the ED and 608% for those who were hospitalized. Firearm injury intent was not specified because of misclassification concerns. In the 6 months after a firearm injury, patient-level health care visits and costs increased by 3 to 20 times compared with the 6 months prior. The burden of firearm injury on the health care system is large and quantifiable. None.

P75. Average costs, length of stay, and 30- and 90-day readmissions in obese and morbidly obese patients who undergo lumbar spine fusion

BACKGROUND CONTEXT Approximately 40% of the United States population is obese, presenting daily challenges to the orthopedic surgeon. Recent studies have shown that obesity is associated with increased complication rates, costs, and readmission rates following lumbar spine fusion, but no granular data exists on how each increasing level of BMI impacts these variables. PURPOSE The purpose of this study is to analyze differences in costs, length of stay, and 30- and 90-day readmission rates in obese and morbidly obese patients. STUDY DESIGN/SETTING A retrospective cohort study was conducted using the National Readmissions Database (NRD) from 2013-2016. PATIENT SAMPLE A total of 56,076 patients with BMI levels of 30-59.9 who underwent primary single and multi-level lumbar spine fusion between the years of 2013-2016. OUTCOME MEASURES Total cost of primary hospital admission, length of stay, and 30- and 90-day readmission rates. METHODS Using ICD-9 and ICD-10 codes, 56,076 patients with BMI levels of 30-59.9 who underwent primary single and multi-level lumbar spine fusion were identified. Patients were grouped into BMI categories of 30-34.9 (group 1), 35-39.9 (group 2), 40-44.9 (group 3), 45-49.9 (group 4), and 50-59.9 (group 5), and total 30- and 90-day readmissions data were collected. Statistical analysis was conducted in R. Kruskal-Wallis tests with Dunn's pairwise comparisons were performed to analyze differences in costs, length of stay, and 30- and 90-day readmission rates between BMI groups. RESULTS Average total cost of admission was $177,153, $176,782, $176,798, $176,698, and $251,723 in groups 1 through 5, respectively. Compared with groups 1-4, group 5 had significantly higher total cost of admission (p CONCLUSIONS Despite an upward trend in 30- and 90-day readmission rates with increasing BMI, the majority of pairwise comparisons between BMI groups showed no statistical significance. Length of stay significantly increased with increased BMI levels. More research is needed to investigate the exact etiologies of differences in readmission rates and length of stay between BMI groups to ensure appropriate risk stratification and postoperative planning. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009.

BackgroundPrevious studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care.MethodsA retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009.ResultsA total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case.ConclusionsExtrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.

Dismal Outcomes and High Societal Burden of Mitral Valve Regurgitation in France in the Recent Era: A Nationwide Perspective.

BackgroundAlthough US recent data suggest that mitral regurgitation (MR) is severely undertreated and carries a poor outcome, population‐based views on outcome and management are limited. We aimed to define the current treatment standards, clinical outcomes, and costs related to MR at the nationwide level.Methods and ResultsIn total, 107 412 patients with MR were admitted in France in 2014 to 2015. Within 1 year, 8% were operated and 92% were conservatively managed and constituted our study population (68% primary MR and 32% secondary MR). The mean age was 77±15 years; most patients presented with comorbidities. In‐hospital and 1‐year mortality rates were 4.1% and 14.3%, respectively. Readmissions were common (63% at least once and 37% readmitted ≥2 times). Rates of 1‐year mortality or all‐cause readmission and 1‐year mortality or heart failure readmission were 67% and 34%, respectively, and increased with age, Charlson index, heart failure at admission, and secondary MR etiology; however, the event rate remained notably high in the primary MR subset (64% and 28%, respectively). The mean costs of hospital admissions and of readmissions were 5345±6432 and 10 080±10 847 euros, respectively.ConclusionsAt the nationwide level, MR was a common reason for admission and affected an elderly population with frequent comorbidities. Less than 10% of patients underwent a valve intervention. All subsets of patients who were conservatively managed incurred high mortality and readmissions rates, and MR represented a major societal burden with an extrapolated annual cost of 350 to 550 million euros (390–615 million US dollars). New strategies to improve the management and outcomes of patients with both primary and secondary MR are critical and warranted.

Diagnostic and lifetime hospital costs of patients suffering from wild-type transthyretin amyloid cardiomyopathy in Denmark

Aims Wild-type transthyretin amyloid cardiomyopathy (ATTRwt) is a fast progressing and fatal disease associated with substantial delays in diagnosis. Between the first symptoms and diagnosis, patients are frequently hospitalized, primarily with cardiac symptoms. After diagnosis, patients continue to experience frequent hospital admissions. The objective of this study was to estimate the Danish diagnostic and lifetime hospital costs associated with the treatment of patients with ATTRwt both before and after they are diagnosed. Materials and Methods We developed a cost model for Danish hospital costs associated with ATTRwt, including the costs of diagnosis, cardiac implants, and hospital admissions covering inpatient hospitalization and outpatient hospital care (ambulatory and emergency services). The number of diagnoses, cardiac implants, inpatient hospitalization and outpatient hospital care were estimated based on published data. Estimates of the unit costs were based on publicly available Danish reference costs. We calculated the total hospital costs covering the median lifespan of patients from onset of symptoms, which is 13 months prior to diagnosis, to 52 months after diagnosis which is the median survival time after diagnosis. Results The average cost of diagnosing ATTRwt was USD 3,424 per patient; the average costs of cardiac implants were USD 1,851 per patient. Hospital admissions costs totaled USD 3,345 pre-diagnosis and USD 59,449 post-diagnosis per patient, on average. The total diagnostic and lifetime (65 months) hospital costs associated with ATTRwt were USD 68,069. Conclusions Caring for patients with ATTRwt places a significant economic burden on the healthcare system. The study emphasizes the cost saving potential for medical interventions in this patient population.