Healthcare Burden Of Patients Research Articles

Performance of anthropometry-based and bio-electrical impedance-based muscle-mass indicators in the Global Leadership Initiative on Malnutrition criteria for predicting prognosis in patients with cancer

BackgroundReduced muscle mass is a criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria; however, the choice of muscle-mass indicators within the GLIM criteria remains contentious. This study aimed to establish muscle-measurement-based GLIM criteria using data from bio-electrical impedance analysis (BIA) and anthropometric evaluations and evaluate their ability to predict overall survival (OS), short-term outcomes, and healthcare burden in patients with cancer. MethodsThis was a multicenter, prospective study that commenced in 2013 and enrolled participants from various clinical centers across China. We constructed GLIM criteria based on various muscle measurements, including fat-free mass index (FFMI), skeletal muscle index (SMI), calf circumference (CC), midarm circumference (MAC), midarm muscle circumference (MAMC), and midarm muscle area (MAMA). Survival was estimated using the Kaplan-Meier method and survival curves were compared using the log-rank test. Cox proportional hazards regression was used to assess the independent association between the GLIM criteria and OS. The discriminatory performance of different muscle-measurement-based GLIM criteria for mortality was evaluated using Harrell's concordance index (C-index). Logistic regression was used to evaluate the association of the GLIM criteria with short-term outcomes and healthcare burden. ResultsA total of 4,769 patients were included in the analysis, of whom 1,659 (34.8%) died during the study period. The Kaplan-Meier curves demonstrated that all muscle-measurement-based GLIM criteria significantly predicted survival in patients with cancer (all p<0.001). The survival rate of malnourished patients was approximately 10% lower than that of non-malnourished patients. Cox proportional hazards regression showed that all the muscle-measurement-based GLIM could independently predict the OS of patients (all p<0.001). The prognostic discrimination was as follows: MAMC (Chi-square: 79.61) > MAMA (Chi-square: 79.10) > MAC (Chi-square: 64.09) > FFMI (Chi-square: 62.33) > CC (Chi-square: 58.62) > ASMI (Chi-square: 57.29). In comparison to the FFMI-based GLIM criteria, the ASMI-based criteria (-0.002, 95% CI: -0.006-0.002, p=0.334) and CC-based criteria (-0.003, 95% CI: -0.007-0.002, p=0.227) did not exhibit a significant advantage. However, the MAC-based criteria (0.001, 95% CI: -0.003-0.004, p=0.776), MAMA-based criteria (0.004, 95% CI: 0.000-0.007, p=0.035), and MAMC-based criteria (0.005, 95% CI: 0.000-0.007, p=0.030) outperformed the FFMI-based GLIM criteria. Logistic regression showed that muscle measurement-based GLIM criteria predicted short-term outcomes and length of hospital stay in patients with cancer. ConclusionAll muscle measurement-based GLIM criteria can effectively predict OS, short-term outcomes, and healthcare burden in patients with cancer. Anthropometric measurement-based GLIM criteria have potential for clinical application as an alternative to BIA-based measurement.

A Retrospective Cohort Study of At-Home Catheter Removal After Urogynecologic Surgery.

In-office postoperative voiding trials (VTs) increase health care burden for patients and physicians. Adoption of an at-home VT option may decrease burden without increasing adverse events postoperatively. The purpose of this study was to compare 30-day postoperative outcomes between participants who performed an at-home autofill VT after catheter self-discontinuation during the Assessing Healthcare Utilization and Feasibility of Transurethral Catheter Self-discontinuation (FLOTUS) study and a "historic" control cohort of patients who presented to the office for backfill-assisted VT on postoperative day (POD) 1. This was a retrospective cohort study of women with postoperative urinary retention after urogynecologic surgery between June 2020 and March 2022. Outcomes from the FLOTUS study were compared with a "historic" control cohort of patients that were identified on chart review from the year before FLOTUS initiation. Demographic, medical history, and procedure-related data were collected. Thirty-day outcome data included office calls/messages, office visits, emergency department visits, complications, and catheterization outcomes. Forty-six participants were included in the FLOTUS cohort and 65 participants in the historic cohort. There was no difference in the POD1 VT pass rate, number of office calls/messages, emergency department visits, or postoperative complications between the 2 cohorts. The FLOTUS patients attended 1 less office visit (1 vs 2 office visits, P <0.001), and this difference persisted on regression analysis (-0.87 office visits; 95% CI, -1.18 to -0.56, P <0.001). Patients who had backfill-assisted VTs on POD1 attended 1 additional office visit compared with those who removed their catheters at home.

Prevalence, incidence and healthcare burden of eosinophilic granulomatosis with polyangiitis in the UK.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare but serious disease characterised by the combination of small-to-medium vessel vasculitis, blood and tissue eosinophilia, and asthma and/or sinonasal disease. This study estimated the prevalence and incidence of diagnosed EGPA in the United Kingdom (UK), and described the demographics, clinical characteristics and healthcare resource utilisation (HCRU) of this population. This retrospective longitudinal study of patients with newly diagnosed EGPA (index) (2005-2019) used the Clinical Practice Research Datalink AURUM and Hospital Episode Statistics databases. The primary outcomes were the annual prevalence (2005-2019) and incidence (2006-2019) of EGPA, and secondary outcomes included patient demographics and clinical characteristics, and HCRU in the year pre- and post-index (diagnosis). Populations of patients with EGPA comprised 940 prevalent cases and 502 incident cases, of which 377 were linked to Hospital Episode Statistics. EGPA prevalence increased from 22.7 to 45.6 cases per 1 000 000 (2005-2019), driven by patients aged ≥18 years. Incidence ranged from 2.3 to 4.0 per 1 000 000 person-years (2006-2019). Pre-index, the most common clinical symptoms were respiratory related, and the most common comorbidities were asthma (80.6%) and nasal polyps (32.1%). Post-index, 19.1% had an EGPA-related inpatient stay (median length of stay 11.0 days) and 38.7% had five or more oral corticosteroid (OCS) prescriptions with a mean OCS possession ratio per patient of 47.0%. Although EGPA incidence in the UK remains relatively stable, prevalence is increasing, and HCRU and OCS use remain frequent, suggesting considerable healthcare burden for patients with EGPA.

ODP230 Outcomes of DKA Based on Hospital Teaching Status: A National Inpatient Sample Analysis

Abstract Introduction Diabetic ketocidosis (DKA) is a serious complication of diabetes mellitus that is responsible for over 100,000 annual hospital admissions in the U. S. There is limited data comparing outcomes of patients with DKA based on the teaching status of the hospital. We aimed to evaluate any differences in terms of mortality, length of hospital stay (LOS) and healthcare burden in patients with DKA admitted in teaching versus non-teaching hospitals. Methods A retrospective cohort study was designed using data obtained from the 2018 National Inpatient Sample (NIS) database. Adult patients (age &amp;gt;18) admitted with a principal diagnosis of DKA were identified using the international diseases classification code, tenthrevision (ICD-10). They were then stratified into two cohorts based on the teaching status of hospital where they were admitted. Primary outcomes assessed were, mortality, length of stay (LOS), total hospital charge and total hospital cost. Secondary outcomes included sepsis, myocardial infarction (MI), intubation, mechanical ventilation, pressors requirement, acute kidney injury (AKI), acute respiratory failure, cerebrovascular accident (CVA) and need for blood transfusion. Results Of the total of 116,710 patients hospitalized with DKA that were analyzed, 65.15% were admitted in teaching hospitals and 34.84% in non-teaching institutions. Most patients in teaching and non-teaching hospitals had an age range between 18 and 44 years (78.6% and 77.6% respectively). Median annual income was between USS1-58,999 in majority of patients admitted in both teaching and non-teaching hospitals (36.42% and 36.99% respectively). A slightly greater proportion of patients admitted in a teaching hospital had either Medicare, Medicaid or a private insurance (87.85% vs 85.35%; p&amp;lt;0. 001). In-hospital mortality was higher in patient admitted in non-teaching institutions (0.22% vs 0.18%) however this was not statistically significant (p: 0.56). Mean LOS was longer in patients admitted in a teaching hospital (3. 05 vs. 2.66 days; p&amp;lt;0. 001). Mean total hospital charges (US$30,978 vs US$25,989; p&amp;lt;0. 001) and mean total hospital cost (US$7,271 vs US$6,942; p&amp;lt;0. 001) were also greater in teaching institutions. Patients admitted in teaching hospitals had higher rate of mechanical ventilation (1.78% vs 1.34%; p: 0. 013) and pressors requirement (0.27% vs 0.14%; p: 0. 038). These patients also had increased rate of AKI (38.79% vs 32.51%; p&amp;lt;0. 001) and acute respiratory failure (2.63% vs 1.94%; p: 0. 01). Other secondary outcomes including sepsis, MI, CVA, need for blood transfusion or intubation were not statistically significant. Conclusion Patients with DKA admitted in teaching hospitals had an increased length of stay, greater total hospital charge and cost. Some secondary outcomes including rate of AKI, acute respiratory failure, mechanical ventilation and pressors requirement were also greater in these patients. The teaching status of the institution did not have a statistically significant impact in terms of mortality or other secondary outcomes like sepsis, myocardial infarction or stroke. Presentation: No date and time listed

Outcomes of paediatric patients with chronic liver disease in early adulthood: A heterogeneous, but representative, regional cohort study.

Advances in paediatric hepatology have led to the increasing survival of patients with paediatric-onset chronic hepatobiliary disease into adulthood. Data are lacking with regard to the outcomes of this heterogeneous group of patients and current transition models may be insufficient. This retrospective regional cohort study examined the outcomes of these patients cared for in a paediatric gastroenterology centre following transfer to adult services. A prospective database of paediatric patients with liver disease identified those already transferred to adult services. Following exclusions, medical notes were examined and health parameters recorded including initial diagnoses, transplant status, fertility and mortality. Descriptive statistics were used to calculate follow-up data and transplant-free survival (TFS). Overall, 63 patients (52% male) entered the final analyses with a median follow-up of 27.5 years. The most common diagnosis was biliary atresia (19%); 27 different diagnoses were apparent within the cohort highlighting the heterogeneity within a single centre. Transplant prevalence at adult transfer was 41%; 14% of patients were lost to follow-up including 10% of transplant patients. TFS for biliary atresia was 17% after 37.4 years follow-up and was 54% for the total cohort. There were seven documented pregnancies and the prevalence of any psychological or psychiatric input was 44%. Transplant complications occurred in 38% of patients; there were two cancer diagnoses and two deaths following transfer. Although overall mortality was low, the health-care burden of patients with paediatric-onset chronic liver disease is high. This group is also very heterogeneous, making structured transition to adult services difficult.

Clostridioides difficile infection in hospitalized patients with leukemia: A nationwide analysis of incidence and outcomes.

e19042 Background: Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea. The incidence and severity of CDI have increased in adults. However, CDI has not been well studied in leukemia patients in the recent years. This study aims to evaluate incidence, mortality, and health care burden in patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of CDI and a concomitant leukemia diagnosis. The control group included non-leukemia patients with CDI. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS) and hospital charges. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 1,235,465 patients were admitted with CDI during the study period. CDI incidence per 100 discharges was higher among leukemia patients, particularly in AML and ALL patients (4.1 and 3.6, respectively) vs. 1 in general population. After adjusting for comorbidities and demographic variables, AML and ALL were independently associated with increased odds of mortality (adjusted odds ratio [AOR] 2.19 and 1.90 respectively: P &lt;0.01). Additionally, both AML and CML had significant mean increase in length of stay (7.2 and 3.1 days respectively; P &lt;0.01) and hospital charges (115,245$ and 87,198$ respectively; P &lt;0.01) compared to non-leukemia patients. Conclusions: Among leukemia patients admitted with CDI, those with AML and ALL have significantly higher adjusted odds of mortality, length of stay, and hospital charges. AML and ALL patients also had the highest incidence of CDI. Applying antibiotic stewardship and appropriately diagnosing and treating CDI is pertinent in these high-risk patients.[Table: see text]

Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review.

The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.

S796 Severe Protein-Calorie Malnutrition Increases Mortality in Patients Admitted With Intestinal Obstruction Secondary to Crohn’s Disease: A Nationwide Analysis

Introduction: The prevalence of malnutrition in Crohn’s disease (CD) ranges between 20% and 85%. Poor nutritional status, as well as selective malnutrition or sarcopenia, is associated with poor clinical outcomes, response to therapy and quality of life. We queried the effect of severe protein-calorie malnutrition (PCM) in patients hospitalized with bowel obstruction secondary to CD. Methods: A retrospective cohort study of the 2016-2017 National Inpatient Sample database was performed, using ICD10-CM/PCS codes to identify patients discharged with a primary diagnosis fibro-stenotic CD and those with a secondary diagnosis of severe PCM. Primary endpoint was in-hospital mortality. Secondary endpoints were length of stay (LOS), in-hospital complications, advanced therapy and hospital related charges. Multivariate regression analysis models to adjust for patient and hospital characteristics and were performed for both primary and secondary outcomes. Results: Of 33,495 patients were discharged with bowel obstruction secondary to CD, 11.3% (3,780) had severe PCM. These patients were more likely to be African American (10.0% vs 12.5%; P = 0.03), had a Charlson score of >3 (3.8% vs 8.2%; P < 0.01), belong to the lower income bracket (21.3% vs 25.3%; P < 0.01), have Medicare (23.5% vs 30.5%; P < 0.01), live on the western US (14.9% vs 18.2%; P = 0.02), be admitted to a large hospital (51.9% vs 62.9%;P < 0.01). Severe PCM patients were more likely to abuse opiates (2.0% vs 4.3%; P < 0.01) and cannabis (2.4% vs 4.2%; P < 0.01), have chronic kidney disease (3.4% vs 5.4%; P < 0.01), require transfusion of blood products (1.6% vs 7.1%; P < 0.01) and parenteral nutrition (1.8% vs 18.4%; P < 0.01). On multivariate analysis, severe PCM patients had higher mortality [OR 4.57; (P < 0.01)] and significant health care burden, including LOS [5.81 days; (P < 0.01)], hospitalization charges [$52,655; (P < 0.01)] and costs [$13,449; (P < 0.01)]. They also had worse clinical outcomes included intubation [ OR 7.59; (P < 0.01)], prolonged mechanical ventilation [OR 14.91; (P < 0.01)], AKI [OR 2.55; (P < 0.01)], shock [OR 16.01; (P < 0.01)], sepsis [OR 3.09; (P < 0.01)], acute respiratory failure [OR 9.67; (P < 0.01)] and venous thromboembolic events (VTE) [OR 7.37; (P < 0.01)]. Conclusion: Severe PCM poses increased mortality and health care burden in patients admitted with bowel obstruction in CD, through worse inpatient clinical outcomes and complications.Table 1.: Comparison of Demographics, Traditional and Non-Traditional Risk Factors between IBD and Non IBD patients

Venous Thromboembolism (VTE) Increases the Healthcare Burden in Patients with Malignant Glioma (MG)

Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. Specific to MG patients, Semrad et al. reported a higher likelihood of death at 2-year follow up (hazard ratio 1.3). The development of VTE is associated with increased mortality, an increased risk of hospitalization, delays in cancer treatment and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. As a result, the economic burden of VTE in cancer patients is substantial and is associated with a nearly 2 fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in MG patients.Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2016. Patients 18 years and older with a histologic diagnosis of malignant glioma, WHO grade 3-4 were assessed. A total of 31 patients were identified and information was collected with respect to their healthcare consumption as related to their oncologic care. Specifically, the number of office visits, emergency room visits, inpatient hospitalizations with the associated costs of VTE management and it's complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption.Results: Of the 31 patients in the study, 10 developed VTE (32%). All patients who developed a VTE were placed on therapeutic anticoagulation as part of VTE management. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. One patient required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatients days (21.3 inpatients days) as compared to their non-VTE counterparts (10 inpatient days), (p=.04). There was a trend towards increased utilization of the emergency room with an average of 5.1 visits in those patients with VTE as compared to those without (2.89), (p=0.244). A limited cost analysis found that anticoagulation management alone generated an additional $84,335 in healthcare costs with an average of $8,433 per patient. A full cost analysis is currently underway.Discussion: The development of VTE in patients with malignant glioma increases inpatient admissions days and pharmaceutical costs related to anticoagulation. While limited in patient number, this represents the first assessment of health care burden associated with VTE specific to this cancer patient population. Given the significant number of MG patients who develop VTE (approximately 1/3 in this study), increases in health care burden are magnified in this patient population and studies are needed to prevent VTE in this particular group of patients. DisclosuresNo relevant conflicts of interest to declare.

Healthcare Burden of Patients with Follicular Lymphoma (FL) in Routine Clinical Care in the United States

Background: Healthcare burden of FL has not been extensively studied in the US. We evaluated healthcare utilization (HCU) and costs for FL patients receiving routine clinical care in the US.Methods: Adult patients newly diagnosed with FL were identified from the Optum claims database (01/01/08 - 10/31/15). The first FL claim was the index date. Patients who initiated FL treatment were followed from index date until end of continuous enrollment, death, end of study period (12/31/15), or transition to diffuse large b-cell lymphomafor the assessment of FL- and non-FL-related HCU and costs. FL-related HCU and costs were medical claims with a primary diagnosis of FL or FL treatment (ie, chemotherapy, radiation, stem cell transplant, and supportive care) and pharmacy claims for FL treatment. The proportion of patients with HCU was reported, and costs were calculated as per-patient-per-month (PPPM) costs and reported as mean (standard deviation [SD]). Patients with a capitated payment plan were excluded from the cost analysis.Results: 1,595 treated FL patients were identified. Over the follow-up, 51.0% of patients had an inpatient admission, 57.2% had an emergency room visit, 92.1% had a physician office visit, and 99.4% had other outpatient visits (Table 1). HCU decreased from Year 1 to Year 2 of the diagnosis. The mean PPPM total costs incurred during the follow-up period was $10,460 (SD: $13,871); costs were higher in Year 1 ($12,183, SD: $13,565), but decreased drastically in Year 2 ($5,062, SD: $10,429). 61% of overall costs were for FL medical services ($6,390 PPPM, SD: $10,308), which decreased from Year 1 ($7,766, SD: $10,217) to Year 2 ($2,670 PPPM, SD: $5,488). This decrease was driven by decreased chemotherapy and supportive care medical services and other outpatient medical services. Non-FL-related medical costs accounted for 36% of the overall PPPM costs ($3,757, SD: $6,793); again, a decrease was noted from Year 1 ($4,101, SD: $6,863) to Year 2 ($2,126, SD: $7,944). A reduction in inpatient admissions was the main driver in this decrease.Conclusions: Economic burden of treated FL patients is high, with the majority of costs incurred during the first year. Costs decreased in the second year, mainly due to decrease in treatment costs. HCU for FL-related services also decreased in the second year after FL diagnosis. [Display omitted] DisclosuresGalaznik:Takeda Pharmaceuticals: Employment, Equity Ownership. Bell:Takeda Pharmaceuticals: Employment, Equity Ownership. Hamilton:Xcenda: Employment; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Consultancy. Ogbonnaya:Xcenda: Employment; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Consultancy. Hennenfent:Xcenda: Employment; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Consultancy. Eaddy:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Consultancy; Xcenda: Employment. Shou:Takeda Pharmaceuticals: Employment, Equity Ownership.

Outcomes of sepsis in patients with multiple myeloma.

e20513 Background: Patients with Multiple Myeloma (MM) are at risk for developing sepsis due to defective humoral immunity, underlying disease factors like renal failure, iron overload, and treatment with immunosuppressive agents. Sepsis is a significant cause of morbidity and mortality in patients with MM. In this study, we aimed to study trends of inpatient outcomes and health care burden of patients with sepsis in MM. Methods: Adult patients with MM admitted to the hospital from 2012 to 2017 were identified from the Nationwide Inpatient Sample database and were stratified into two groups based on the diagnosis of sepsis. Multivariate regression analysis was used to adjust for confounders when calculating for mortality. Statistical tests for trends of mortality, length of stay and hospital charges were performed. Results: A total of 513,615 patients with MM met the inclusion criteria. Sepsis was found to be the most common cause of admission amongst these patients (12.2%) and of the patients with MM who died in the hospital, 38.1% carried the primary diagnosis of sepsis. Mean age of the patients was 70.1 years and they were predominantly Caucasian (62.1%) with male preponderance (57.7%). MM patients admitted with sepsis were found to have higher mortality (15.7 and 3.5% P &lt; 0.0001),higher hospital costs (22,082$ vs 15,206; P &lt; 0.0001) and longer hospital stays (8.1 days vs 6.0 P &lt; 0.0001) when compared to those admitted for other reasons. Temporal trends have been noted to improve over the years, with mortality decreasing from 18% to 13.1%, (p trend &lt; 0.001). Length of stay (in days) decreased from 8.3 to 7.7 days (p trend = 0.009) and hospital charges (in dollars) decreased from 22,407 to 21,209 (p trend &lt; 0.001). Conclusions: Although the improving trends are promising, sepsis still continues to be significantly contributing to morality and morbidity in patients with MM. Measures to identify the changing spectrum of infectious diseases, their predisposing risk factors along with strategies to recognize and prevent early stages of sepsis could have a significant impact on lowering mortality and health care burden. [Table: see text]

Inpatient outcomes and predictors of mortality in patients with gastrointestinal malignancies presenting with sepsis: A nationwide analysis.

4045 Background: Sepsis is a frequent cause of morbidity and mortality in patients with malignancy. However, there is paucity of literature on mortality, hospital charges and overall healthcare utilization among patients with GI malignancy, which we hope to characterize in this study. Methods: We queried retrospective data from the Nationwide Inpatient Sample (NIS) database for the year 2016. Sepsis (Dx1) was identified using ICD-10 code as primary diagnosis in patients with known GI malignancies (Dx2). Univariate and multivariate Poisson regression analysis was done to study outcomes. Propensity score matching was done to minimize confounding factors. Primary outcome was inpatient mortality. Secondary outcomes were Length of Stay (LOS), Total Charge (TOTCHG) and ICU admission. Results: A total of 43,240 patients with GI malignancy were admitted in 2016 with sepsis. Two most common GI malignancies admitted with sepsis were colorectal (35%) and hepato-cellular cancer (HCC) (28.2%). Overall mortality in GI cancer was 19.8% vs 10.2% in all cancers (p&lt;0.01). There was male (59%) and Caucasian (63%) preponderance. Out of all hospital admissions for GI malignancy, 41.4% were secondary to sepsis. E. coli (31%) infection and gram-negative bacteremia (15%) were the most common causes of sepsis. Sepsis with GI malignancy was associated with length of stay of 7.4 days vs 5.4 days (coef 2.44, 95% CI 2.3-6.7 p=0.04) and a mean hospital charge of $88,728 vs $ 54, 668 (coef 34,140, 95% CI 44,264-90,646, p&lt;0.01) as compared to without sepsis. After adjusting for demographic and patient related variables, independent predictors of mortality were old age, uninsured, African Americans, septic shock requiring pressor support, AKI, inpatient hemodialysis, metabolic encephalopathy and acute respiratory failure. Conclusions: Sepsis poses a substantial healthcare burden in patients with GI malignancy and is a major cause of mortality. Early antibiotic treatment is necessary for sepsis control in patients with GI malignancy. [Table: see text]

Stakeholder perspectives of the clinical utility of pharmacogenomic testing in solid organ transplantation.

Aims: To assess stakeholder perspectives regarding the clinical utility of pharmacogenomic(PGx) testing following kidney, liver, and heart transplantation. Methods: We conducted individual semi-structured interviews and focus groups with kidney, liver, and heart transplantation patients and providers. We analyzed the qualitative data to identify salient themes. Results: The study enrolled 36 patients and 24 providers. Patients lacked an understanding about PGx, but expressed interest in PGx testing. Providers expressed willingness to use PGx testing, but reported barriers to implementation, such as lack of knowledge, lack of evidence demonstrating clinical utility, and patient healthcare burden. Conclusion: Patient and provider educational efforts, including foundational knowledge, clinical evidence, and applications to patient care beyond just immunosuppression, may be useful to facilitate the use of PGx testing in transplant medicine.

Osteoporotic Fracture Risk and Health Care Burden in Patients With Cirrhosis.

Risk factors for osteoporotic fracture as well as inpatient utilization and mortality have not been thoroughly studied in patients with cirrhosis. We analyzed data from a national database to determine fracture risk in patients with cirrhosis, specific risk factors, and the effect of fractures on health care utilization. We performed an observational study using serial cross-sectional data to examine fracture-related hospitalizations of patients with cirrhosis using the National Inpatient Sample from 2012 to 2013. We collected data on fracture-related hospitalizations and utilization in the form of length of stay (LOS), total hospital costs, and inpatient mortality. We used multivariate regression to determine risk factors for fracture and fracture-related mortality. Patients with cirrhosis and an osteoporotic fracture had a mean LOS of 10.4 days and incurred $26,582 per hospitalization, which were statistically different from noncirrhotic patients with fracture (LOS: 6.60 d, cost: $17,918) and cirrhotic patients without fracture (LOS: 7.84 d, $18,912). Malnutrition was associated with increased odds of fracture [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.20-1.39] and inpatient mortality (OR, 1.40; 95% CI, 1.12-1.76). Obesity was protective against both fracture (OR, 0.78; 95% CI, 0.71-0.85) and fracture-related mortality (OR, 0.82; 95% CI, 0.59-1.14). Hospitalizations for osteoporotic fractures in patients with cirrhosis are a significant source of health care burden and mortality. More attention should be paid to screening patients with cirrhosis for low bone mass. Malnutrition is associated with increased fracture risk and fracture-related mortality, representing a modifiable risk factor worthy of addressing in patients with cirrhosis.

ATRIAL FIBRILLATION WELLNESS PROGRAM LEADS TO DECREASED EMERGENCY ROOM VISITS AND 30 DAY RE-HOSPITALIZATION RATES

Emergency room visit and re-Hospitalization within 30 days leads to significant health care burden in patients with symptomatic atrial fibrillation (AFIB). We postulated that an Atrial Fibrillation Wellness Program (AFWP) by initiating risk factor modification along with a specific resource for

Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization.

IntroductionHypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D.MethodsHypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined.ResultsOf 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P < 0.001). Data, adjusted for baseline characteristics such as age, any baseline hypoglycemia, and use of oral antidiabetes drugs, showed that patients with hypoglycemia had a greater risk of discontinuation (hazard ratio 1.16; 95% confidence interval 1.03, 1.32; P = 0.0164), were more likely to have a hospitalization (41.0% vs. 24.3%; P < 0.001) or an ED visit (55.8% vs. 35.1%; P < 0.001), and had higher diabetes-related ($13,662 vs. $7506; P < 0.001) and all-cause ($30,719 vs. $19,079; P < 0.001) healthcare costs.ConclusionsUS patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden.FundingSanofi US, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0592-x) contains supplementary material, which is available to authorized users.

MEDU-17. SEXUALLY DIMORPHIC ROLES OF STAT3 IN MEDULLOBLASTOMA

AbstractMedulloblastoma is the most common childhood malignant brain tumour, and represents 20% of all paediatric central nervous system neoplasms. Although advances in surgery, radiation and chemotherapy have improved overall survival, the lifelong sequelae of these treatments represents a major health care burden for patients, parents, and society. Recent progress in the molecular subtyping of medulloblastoma have revealed at least four distinct subsets of tumours with dramatically different biology. Additionally, medulloblastoma predominately occurs in males and maleness correlates with worse outcome. However, the drivers of this sexual dimorphism in medulloblastoma are unclear. We have identified that STAT3 is one such factor. Deletion of STAT3 from granule cell precursors in a mouse model of SHh medulloblastoma driven by the loss of one PTCH1 allele results in complete protection of males, but has no effect in females. Stratification of transcriptomics data from a cohort of SHh medulloblastoma patients on the basis of STAT3 expression shows that male patients with low STAT3 expression have improved overall survival - an outcome not observed in females. Additionally, we identified STAT3-dependent genes, specific to males which correlate with overall survival. This is one of the first observations of a gene that could, in part, explain the sex dimorphism in medulloblastoma and offer insights into altered treatment options for patients on the basis of their sex and/or STAT3 expression.

Health Care Burden in Patients With Adrenal Insufficiency.

Objective:This study aimed to estimate the annual health care burden for patients with adrenal insufficiency [AI; primary (PAI), secondary to pituitary disorder (PIT), and congenital adrenal hyperplasia (CAH)] using real-world data.Methods:Using a US-based payer database comprising >108 million members, strict inclusion criteria with diagnostic codes and pharmacy records were used to identify 10,383 patients with AI. This included 1014 patients with PAI, 8818 with PIT, and 551 with CAH, followed for >12 months. Patients were matched 1:1 to controls, based on age (±5 years), sex, insurance, and region. Multivariable expenditure models were estimated for each AI cohort vs controls as well as subsets by glucocorticoid therapy (hydrocortisone, dexamethasone, prednisone, or multiple therapies). A separate multivariable model was estimated to assess the association between adherence and expenditures.Results:Total annual health care expenditure estimates were significantly higher (P < 0.0001) in all AI cohorts compared with matched controls (PAI $18,624 vs $4320, PIT $32,218 vs $6956, CAH $7677 vs $4203). Patients with AI have more frequent inpatient hospital stays with up to eight to 10 times more days in the hospital per year than their matched controls. In each AI cohort, patients on multiple steroid therapies had higher expenditures in comparison with patients using hydrocortisone therapy alone. In PAI and PIT cohorts taking hydrocortisone only, fewer expenditures were found in higher adherence subsets.Conclusion:Patients with AI demonstrate a substantial annual health care burden. Expenditures vary by underlying cause and treatment and are reduced in patients with higher adherence to glucocorticoid replacement.

Higher all-cause hospitalization among patients with chronic hepatitis C: the Chronic Hepatitis Cohort Study (CHeCS), 2006-2013.

In the United States, hospitalization among patients with chronic hepatitis C virus (HCV) infection is high. The healthcare burden associated with hospitalization is not clearly known. We analysed data from the Chronic Hepatitis Cohort Study, an observational cohort of patients receiving care at four integrated healthcare systems, collected from 2006 to 2013 to determine all-cause hospitalization rates of patients with chronic HCV infection and the other health system patients. To compare the hospitalization rates, we selected two health system patients for each chronic HCV patient using their propensity score (PS). Propensity score matching was conducted by site, gender, race, age and household income to minimize differences attributable to these characteristics. We also compared primary reason for hospitalization between chronic HCV patients and the other health system patients. Overall, 10 131 patients with chronic HCV infection and 20 262 health system patients were selected from the 1 867 802 health system patients and were matched by PS. All-cause hospitalization rates were 27.4 (27.0-27.8) and 7.4 (7.2-7.5) per 100 persons-year (PY) for chronic HCV patients and for the other health system patients, respectively. Compared to health system patients, hospitalization rates were significantly higher by site, gender, age group, race and household income among chronic HCV patients (P < 0.001). Compared to health system patients, chronic HCV patients were more likely to be hospitalized from liver-related conditions (RR = 24.8, P < 0.001). Hence, patients with chronic HCV infection had approximately 3.7-fold higher all-cause hospitalization rate than other health system patients. These findings highlight the incremental costs and healthcare burden of patients with chronic HCV infection associated with hospitalization.

Oropharyngeal Reflux Monitoring and Atypical Gastroesophageal Reflux Disease.

The prevalence of gastroesophageal reflux disease (GERD) has been increasing since the 1990 s, with up to 27.8 % of people in North America affected by this disorder. The healthcare burden of patients who primarily have extra-esophageal manifestations of GERD (atypical GERD) is estimated to be 5 times that of patients with primarily heartburn and regurgitation due to lack of a gold standard diagnostic test, poor responsiveness to PPI therapy, and delay in recognition. Empiric twice daily PPI therapy for 1-2 months is currently considered the best diagnostic test, but due to poor responsiveness to PPIs in patients with atypical GERD in multiple randomized controlled trials, newer modes of diagnostic procedures such as oropharyngeal pH monitoring have gained significantly more traction. The utility of oropharyngeal pH monitoring systems such as Restech Dx-pH is currently limited due to lack of consensus on normal and abnormal cutoff values. Recent studies suggest its utility as a prognostic tool and its ability to predict responsiveness to medical and surgical therapy. However, routine use of oropharyngeal pH monitoring is still not widespread due to the lack of well-controlled prospective studies.