Euros For Patients Research Articles

Intensive care\u2013treated cardiac arrest: a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

BackgroundCardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital.MethodsThis single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ge75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome.ResultsThis study included a total of 1,285 patients, of which 212 (16 %) were ge75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24 % of the patients in the elderly group and 47 % of the patients in the younger group had a CPC of 1–2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 2.90, 95 % CI: 1.94–4.31, p < 0.001) and neurological outcome (multivariate OR = 3.15, 95 % CI: 2.04–4.86, p < 0.001).ConclusionsThe elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Elderly received less intense treatment. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.

P0593INCIDENCE AND IMPACT OF ACUTE KIDNEY INJURY (AKI) IN A THIRD LEVEL HOSPITAL

Abstract Background and Aims The AKI index is increasing, reaching 22% in hospitalized patients. Despite the negative impact it implies, in daily practice its management remains suboptimal and there is little awareness of the problem. Aims: Know the incidence of AKI in a Third-level hospital; its impact on mortality, average stay and associated costs. Method Descriptive cross-sectional study of data extracted from CMBDA corresponding to a third level hospital during 2016-17. We analyze: hospitalization episodes, referral assistance units, AKI episodes at discharge, stays and exitus. To calculate associated costs, we use as reference the costs/day-hospitalization per Healthcare Unit in SAS according to BOJA-Number 218 (14nov2016). We compare groups according to presence/no AKI. Limitations: These data may be underestimated since the diagnosis of AKI may be present and not reported upon discharge; Nor do we include dialysis costs. Results 56,816 revenues were produced; 3,589 reported AKI (incidence: 6.31%). Patients with AKI add 42,801 stays; Average stay of 18.4 days in 2016, 16.4 in 2017, compared to 6.6 and 8.7 days respectively when FRA is not associated (p &amp;lt;0.01). The estimated costs associated with the FRA were 22,815,558 euros, with a cost / episode of 6023 euros, compared to 3523 euros in patients without FRA. The overall associated mortality AKI was 23.2% vs 11% in the rest (p &amp;lt;0.01). Average stay, costs and mortality vary widely according to the Assistance Units, the impact being especially worrying in Surgical Units (table). Conclusion The incidence of AKI in our hospital lower than that referred to in the literature probably responds to inadequate registration in discharge reports. Despite the limitations, our data demonstrate the impact of the diagnosis of AKI in hospitalized patients, doubling the average stay, costs and mortality. These differences are accentuated in some Assistance Units, being especially alarming in Surgical Units.

The revenue from finger replantation and revision amputation: Is it cost-covering?

Finger amputation injuries are frequently treated conditions in occupational accident hospitals. They are either treated by replantation or revision amputation. The costs of these two treatment options differ significantly. This study aims to determine if the revenue generated from the treatment of finger amputation injuries in the German DRG system is cost-covering and if there are differences depending on the type of health insurance. Based on our hospital's cost data from the years 2014 and 2015, we performed an analysis of the revenue generated from finger replantation and finger revision amputation and compared it with the cost data of the nationwide calculation hospitals in Germany. In addition, we compared the revenue generated from patients with statutory health insurance with the revenue from patients with workers' compensation insurance. During the study period, a total of 90 patients were treated for finger amputation. For primary finger revision amputation, the actual costs were lower compared to the cost data of the nationwide calculation hospitals (€ 3551 vs. € 3809, p = 0.442). After deduction of all costs, the revenue was 1,008 Euros for patients with statutory health insurance and 688 Euros for patients with workers' compensation insurance (p = 0.578). In contrast, the costs of complex finger reconstruction procedures were considerably underestimated. In cases of primary finger replantation or secondary finger revision amputation, losses of 260 Euros were recorded for patients with statutory health insurance. In patients with workers' compensation insurance, the revenue of complex finger reconstruction procedures after deduction of all costs was cost-covering (€ 900, p = 0.403). In the German DRG system, the reimbursement for the treatment of finger amputation depends on the type of health insurance. In patients with workers' compensation insurance, cost-covering revenue is generated from both finger revision amputation and finger replantation, whereas in patients with statutory health insurance, only the revenue of primary finger revision amputation appears to be cost-covering. Hence for finger amputation injuries with subsequent complex reconstruction procedures, a revision of the cost calculation is required to avoid inappropriate incentives in patient care.

Estimación del coste hospitalario del cáncer colorrectal en Cataluña

ObjectiveTo assess the hospital cost associated with colorectal cancer (CRC) treatment by stage at diagnosis, type of cost and disease phase in a public hospital. MethodsA retrospective analysis was conducted of the hospital costs associated with a cohort of 699 patients diagnosed with CRC and treated for this disease between 2000 and 2006 in a teaching hospital and who had a 5-year follow-up from the time of diagnosis. Data were collected from clinical-administrative databases. Mean costs per patient were analysed by stage at diagnosis, cost type and disease phase. ResultsThe mean cost per patient ranged from 6,573 Euros for patients with a diagnosis of CRC in situ to 36,894 € in those diagnosed in stage III. The main cost components were surgery-inpatient care (59.2%) and chemotherapy (19.4%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs and an increase in chemotherapy costs. ConclusionsThis study provides the costs of CRC treatment based on clinical practice, with chemotherapy and surgery accounting for the major cost components. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Assessment of pharmacological strategies for management of major depressive disorder and their costs after an inadequate response to first-line antidepressant treatment in primary care

BackgroundThe aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care.MethodA retrospective cohort study of medical records from six primary care centers was conducted. Adults with a major depressive disorder diagnosis, at least 8 weeks of AD treatment after the first prescription, and patient monitoring for 12 months were analyzed. Healthcare (direct cost) and non-healthcare costs (indirect costs; work productivity losses) were described.ResultsA total of 2,260 patients were studied. Forty-three percent of patients (N = 965) presented an inadequate response to treatment. Summarizing the different treatment approaches: 43.2% were switched to another AD, 15.5% were given an additional AD, AD dose was increased in 14.6%, and 26.7% remained with the same antidepressant agent. Healthcare/annual costs were 451.2 Euros for patients in remission vs. 826.1 Euros in those with inadequate response, and productivity losses were 991.4 versus 1,842.0 Euros, respectively (p < 0.001).ConclusionAntidepressant switch was the most common therapeutic approach performed by general practitioners in naturalistic practice. A delay in treatment change when no remission occurs and a significant heterogeneity in management of these patients were also found.

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery

This study investigated the cost-effectiveness of ultrasonographic-guided interscalene brachial plexus blockade (ISB) in comparison with general anaesthesia (GA) for arthroscopic shoulder surgery. Forty patients undergoing arthroscopic shoulder surgery received either an ultrasonographic-guided ISB or GA. ISB was performed outside the operation room (OR) and patients were transferred in the OR at the earliest 20 min after block performance. All drugs and disposables were recorded to evaluate the costs for both techniques. The following anaesthesia-related times were defined: ready for surgical preparation (from arrival in the OR until end of anaesthesia induction), OR emergence time (from end of dressing until leaving the OR), anaesthesia control time (from patient's arrival in the OR until readiness for positioning plus time from the end of surgery to patient's discharge from the OR), and post-anaesthesia care unit (PACU) time (from patient's arrival in the PACU to the eligibility for discharge to normal ward). Personnel costs were excluded from statistical analysis. The total costs were [mean (sd)] 33 (9)euro for patients with ISB and 41 (7)euro for those who received GA (P<0.01). The anaesthesia-related workflow was improved in the ISB group when compared with the GA group [ready for surgical preparation 8 (3) vs 13 (5) min, P<0.001; OR emergence time 4 (3) vs 10 (5), P<0.001; anaesthesia control time 12 (4) vs 23 (6), P<0.001; and PACU time 45 (17) vs 70 (20), P<0.001]. Ultrasonographic-guided ISB is a cost-effective method for arthroscopic shoulder surgery.

Perfil de comorbilidad, grado de control, uso de recursos sanitarios y presencia de evento cardiovascular en sujetos con hipertensión arterial en el ámbito de la atención primaria de salud

Objective To determine comorbidity, degree of control and costs according to the presence/absence of cardiovascular events (CVE) in primary health care (PHC) patients with hypertension (HT). Patients and methods A retrospective multicenter study. Patients aged >30 years from five PHC teams were included in 2006. Comparative cohort: general population. Main measures: CVE, Charlson Comorbidity Index (severity), comorbidity (Adjusted Clinical Groups), clinical parameters (blood pressure, lipids, glycemia, etc.) and degree of control. Optimal control (<140/90, and ≤130/80 mmHg in diabetics and patients with CVE) and moderate control (≤140/90 mmHg) was established according to NCEP-ATP III criteria. A model of direct costs was established, differentiating between fixed and variable (drugs, tests and referrals) costs. Models were corrected using logistic regression analysis and ANCOVA tests, with a level of significance p<0.05. Results In total 57,025 patients were included, of whom 26.5% (95% confidence intervals, [CI]: 25.8–27.2%) had HT. Hypertensives had a higher age (67.6 vs. 49.5 years), proportion of women (56.9% vs. 54.0%), general morbidity (7.1 vs. 4.2 episodes/year) and Charlson Comorbidity Index (0.9% vs. 0.3%), p<0,001. HT was independently associated with obesity (OR=2.9), diabetes (OR=2.1), dyslipidemia (OR=1.9), CVE (OR=1.3) and age (OR=1.1). Optimal control was observed in 52% of patients (56.0% without CVE and 35.1% with CVE, p<0.001). The mean unit cost was 457.90 euros in the general population, 1,171.80 euros in patients with HT and 1,757.09 euros in patients with CVE. The adjusted mean unit cost (ANCOVA) was 565.29 euros, 870.21€ and 1,504.35 euros, respectively, p<0,001. These differences were maintained for all cost components. Conclusions Optimal control can still be improved. Patients with HT consume a large amount of health resources. HT should be considered together with other cardiovascular risk factors.

Direct costs associated with mild cognitive impairment in primary care

Little is known about the direct costs of individuals with Mild Cognitive Impairment (MCI). This study investigates the direct costs associated with MCI according to recent diagnostic criteria from a societal perspective. Four hundred and fifty-two primary care patients aged 75+ from Leipzig, Germany, were investigated in face-to-face interviews regarding MCI according to the current diagnostic criteria of the International Working Group on MCI, resource utilisation and costs (questionnaire of service utilisation and costs), as well as chronic medical illness (Chronic Disease Score). Resource utilisation was monetarily valued using 2004/2005 prices. Mean annual direct costs were 4,443 euro for patients with MCI (n=39) and 3,814 euro for patients without MCI (n=413) (p=0.34). Looking at the cost components, patients with and without MCI only significantly differed regarding pharmaceutical costs (1,210 euro vs 1,062 euro; p<0.05) not caused by antidementive drugs. Direct costs of individuals having MCI are not significantly increased in comparison to direct costs of individuals without cognitive deficits.

Utility loss and indirect costs following cardiovascular events in hypertensive patients: the ASCOT health economic substudy

This study assessed the loss of utility and indirect costs associated with first cardiovascular events. Data was collected (using EQ-5D) prospectively at 3, 6, and 12 months following an event in the Swedish part of the Anglo-Scandinavian cardiac outcomes trial (ASCOT), including patients with mild to moderate hypertension and additional risk factors. Sixty patients were eligible for analysis. An event was associated with a one-year utility loss of 0.075 (95% CI: 0.038-0.114). For a stroke, the reduction was 0.145 (CI: 0.059-0.249) and for acute coronary syndromes (myocardial infarction or unstable angina) the loss was 0.051 (-0.003 to 0.103). The utility at baseline was no different to the utility in a control group. The indirect cost over the first 12 months (2003 Swedish Kronor, SEK) was 90028 SEK (CI: 46027-146754), 9866 euro for patients in the workforce. These results are helpful in future economic evaluations of primary preventive measures in cardiovascular medicine.

Left ventricular hypertrophy and cardiovascular risk stratification: impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives

Echocardiography is more accurate than electrocardiography in the assessment of cardiac target organ damage related to hypertension, thus leading to a more precise stratification of total cardiovascular risk. However, ultrasound examination of the heart on a routine basis remains a matter of debate. To evaluate the impact and cost-effectiveness of echocardiographic examination on global risk stratification in low and medium-risk hypertensive patients in relation to age and sex. A total of 580 untreated hypertensive individuals (355 men and 225 women, mean age 47.8 +/- 11.4 years), classified at low to medium risk, according to routine clinical work-up suggested by the 2003 European Society of Hypertension/European Society of Cardiology guidelines, were included in the study. Total risk was reassessed by adding the results of ultrasound examination of the heart. Left ventricular hypertrophy (LVH) was defined as a left ventricular mass index of 125 g/m2 or more in men and 110 g/m2 or more in women. The impact of LVH in stratifying risk was assessed according to age (< 50 and > or = 50 years) and sex. According to routine classification, 16.3% (n = 93) of the 580 patients were considered to be at low added risk and 83.7% (n = 487) at medium added risk. In the whole population, echocardiographic LVH was found in 86 patients (14.8%) who were then reclassified in the high-risk stratum. The prevalence rates of patients reclassified in the high-risk class as a consequence of LVH detection, according to age and sex, were as follows: 8.9% in men under 50 years, 12.3% in women under 50 years, 26.7% in men aged 50 years and over and 15.3% in women aged 50 years and over. The cost per detected case of LVH was 595 euros in patients under 50 years of age and 290 euros in those 50 years of age and older. Our findings indicate that the prevalence of LVH, and consequently the probability of upgrading the total cardiovascular risk profile, is highest in the group of old hypertensive men; echocardiography has a limited impact on the risk reclassification in younger patients and an unfavourable cost-effectiveness profile. Our data thus do not support the systematic ultrasound assessment of the heart in all uncomplicated hypertensive individuals.

Direct medical costs of age-related macular degeneration in Italian hospital ophthalmology departments. A multicenter, prospective 1-year study.

This study calculated the resource utilization and direct medical costs related to age-related macular degeneration (AMD). We conducted a multicenter observational study in 1999 in seven hospital ophthalmology departments in northern and central Italy. A total of 476 patients aged over 50 years with the diagnoses were classified into three prognostic groups: (a) drusen (23.7%), (b) geographic atrophy (16.4%), and (c) retinal changes associated with choroidal neovascularization (CNV) (59.9%). In addition to the costs reimbursed by the Italian National Health Service, we estimated also patients' out of pocket expenses. The mean cost per patient per year was 383.2 euro; patients with CNV were by far the most costly (540.1 euro, vs. 158.1 euro for drusen and 147.9 euro for geographic atrophy). Hospital costs and diagnostics were the main cost determinants. Services directly paid for by patients (private consultations and OTCs) amounted to 46.5 euro for patients with CNV, 50.3 euro for drusen, and 68.8 euro for geographic atrophy. The major finding of the study was that the presence of CNV involved higher expenditure than drusen or geographic atrophy. This suggests that the costs of AMD rise significantly with the severity of the illness.