Hospital Healthcare Costs Research Articles

Use of Health Resources and Healthcare Costs associated with Frailty: The FRADEA Study.

Frailty is associated with adverse health outcomes, but its association with hospital healthcare costs has not been analyzed. The main objective was to estimate the adjusted annual costs and use of hospital healthcare resources in frail older adults compared to non frail ones. FRADEA Study. Mean follow-up 1044 days (SD 314). Albacete city, Spain. 830 adults ≥70 years. Age, sex, comorbidity measured with the Charlson index and Fried´s Frailty phenotype as independent variables, and use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs as outcome variables. Outcome data were collected from Minimum Data Set of the Complejo Hospitalario Universitario Albacete. The cost base year was 2013. Logistic regression and two-part models were used to analyze the association between frailty and the use of healthcare resources. Generalized Linear Models were applied to estimate the impact of frailty and comorbidity on the healthcare costs. The average cost associated with the use of health resources was 1,922€/year. Frail participants had an average total cost of health resources of 2,476€/year, pre-frail 2,056€/year, and non-frail 1,217€/year. 67% of the total health cost was associated with hospital admission cost, 29% with specialist visits cost and 4% with emergency visits cost. Frailty and comorbidity were the most important factors associated with the use of hospital healthcare resources. Adjusted healthcare costs were 592€/year and 458€/year greater in frail and pre-frail participants respectively, compared to non-frail ones, and having a Charlson index ≥ 3, was associated with an increased costs of 2,289€/year. Frailty and comorbidity are meaningful and complementary associated with increased hospital healthcare resources use, and related costs.

Retrospective database study to assess the economic impact of hip fracture in the United Kingdom

Objective:Publications containing recent, real-world data on the economic impact of hip fractures in the UK are lacking. This retrospective electronic medical records database analysis assessed medication and healthcare resource use, direct healthcare costs, and factors predicting increased resource use and costs in adult UK hip fracture patients.Methods:Data were obtained from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics for adult patients hospitalized for their first hip fracture between January 1, 2006 and March 31, 2011 (index event); healthcare costs were calculated from the National Health Service perspective using 2011–2012 cost data.Results:Data from 8028 patients were analyzed. Resource use and costs were statistically significantly higher in the year following fracture (mean total [standard deviation (SD)] cost £7359 [£14,937]) compared with the year before fracture (mean total [SD] cost £3122 [£9435]; p < 0.001), and were similar to the total amount of the index hospitalization (mean total [SD] cost £8330 [£2627]). Multivariate regression analysis (using an estimated generalized linear model) showed that older age, male gender, higher comorbidity, osteoporosis, discharge to another institution compared with home, and pre-index hospitalization and outpatient visits were associated with increased post-index hospitalization healthcare costs (all p < 0.05).Conclusions:Although we did not capture all pre- and post-index costs and healthcare utilization, this study provides important insights regarding the characteristics of patients with hip fracture, and information that will be useful in burden-of-illness and economic analyses.

Surviving Intensive Care

Intensive care survivors continue to experience significant morbidity following acute hospital discharge, but healthcare costs associated with this ongoing morbidity are poorly described. As the demand for intensive care increases, understanding the magnitude of postacute hospital healthcare costs is of increasing relevance to clinicians and healthcare planners. We undertook a systematic review of the literature reporting major healthcare resource use by intensive care survivors following discharge from the hospital and identified factors associated with increased resource use. Seven electronic databases (1990 to August 2012), conference proceedings, and reference lists were searched. Studies published in English were included that reported postacute hospital discharge healthcare resource use at the individual level for survivors of intensive care. Two reviewers screened abstracts and one abstracted data using standardized templates. Study quality was assessed using recognized appraisal methods specific to economic evaluation, epidemiological studies, and randomized trials. From 4,909 articles, 18 articles representing 14 cohorts fulfilled inclusion criteria. There was substantial variation in methodology, especially the resource categories included in the studies. Following standardization to a common currency and year, variation in cost of resource use was evident (range 2011 US $18,847-$148,454 for year 1 postdischarge). Studies undertaken within the United States reported the highest costs; those in the United Kingdom reported substantially lower costs. Factors associated with increased resource use included increasing age, comorbidities, organ dysfunction score, and previous resource use. Wide variation in methodological approaches limited study comparability and external validity of findings. We found substantial variation in the cost of resource use, especially among countries. Careful description of patient cohorts and healthcare systems is required to maximize generalizability. We give recommendations for a more standardized approach to improve design and reporting of future studies.

Hospital Variation in Readmission After Coronary Artery Bypass Surgery in California

Readmissions are common after coronary artery bypass grafting (CABG) surgery and account for a significant percentage of hospital healthcare costs. Readmission rates also vary widely between hospitals, but the reasons for this variation have not been studied previously. We linked 2009 California CABG clinical registry data to hospital discharge data for 2009 and 2010 to identify 30-day readmissions for all patients undergoing isolated CABG surgery. Both standard and hierarchical logistic models were developed to predict readmission risk and explore sources of hospital readmission variation. Among 11 823 patients discharged alive after isolated CABG in 2009, 1565 (13.2%) patients were readmitted within 30 days of surgery. Heart failure and postoperative infections were the most frequent reasons for readmission (15.3% and 12.9%, respectively). Multiple patient risk factors, including age, sex, and lower zip code-level median household income, were significant predictors of readmission (all adjusted odds ratios >1.0; P<0.05). The readmission rates among the 119 hospitals performing CABG varied from 0% to 26.9%. Compared with hospitals in lower quartiles for readmission, hospitals in higher quartiles had a significantly higher readmission rates due to circulatory diseases, infections, complications for surgical and medical care and digestive diseases (all P<0.05). In a hierarchical model, including several hospital characteristics, hospital-level variables did not predict readmission risk (all P>0.05, with an intraclass correlation of 0.004 for hospitals). California hospitals performing CABG surgery vary widely in 30-day readmission rates. Patient demographic and clinical risk factors, rather than measured hospital characteristics, accounted for most of the observed hospital-level variation in CABG readmissions.

P1-10-02: Burden of Brain Metastases in HER2−Positive Breast Cancer: Healthcare Use and Costs from a French Observational Retrospective Multicenter Study.

Abstract Background HER2+ status is associated with poor prognosis and a high incidence of brain metastases (BM) in breast cancer (BC). Addition of HER2−targeted therapies to conventional chemotherapy has significantly improved survival in HER2+ patients (pts). Management of BM implies a multidisciplinary therapeutic approach involving medical oncology, radiation oncology and neurosurgery teams. Nevertheless available data evaluating health resources use and associated costs are limited. Our objective was to describe treatment patterns and healthcare costs associated with HER2+ BMBC patients. Patients and methods An observational retrospective study was conducted on 207 HER2+ BC pts, newly diagnosed with BM as first site of relapse or as secondary metastases between January 2006 and December 2008. Pts were recruited in 10 hospitals, all funded by a prospective payment system based on Diagnosis Related Groups (DRG). Individual data concerning initial diagnosis, distant and BM relapses, treatments, complications and hospitalization stays were collected during a 2 year — follow-up. DRGs 2007 official tariffs (per-case payment basis) and 2007 expensive innovative drugs tariffs (drugs paid to hospitals by Health Insurance in addition to per-case payments) were used to estimate direct medical costs from the Health Insurance perspective. Survival was estimated using Kaplan Meier method. In the presence of cost-censored data, a partitioned estimator was used to adjust censoring costs (Bang and Tsiatis, Biometrics, 2002). Results 91.8% (190/207) of BMBC pts received radiation therapy, 84.5% (175/207) received chemotherapy including HER2 targeted treatments and 12.6% (26/207) were treated by neurosurgery. 72.5% (150/207) of pts were hospitalized at least once during the follow-up period. Pts had on average 2.90 hospital stays (range 1–8). The median duration of stay was 9 days (1-221). Complications leading to re-hospitalization were recorded in 45.9% (95/207) of pts. The median overall survival from the diagnosis of BM was 13 m. Hospital healthcare costs were concentrated on the 6 first months following BM diagnosis. Mean cost of BMBC management was 18,480€/patient within the 6 first months and decreased to 16,306€ from 7–12 months, 15,844€ from 13–18 months, and 15,225€ from 19–24 months. The proportion of costs attributed to inpatient hospitalizations stay (treatments and complications) was similar to the one attributed to drugs whatever the period of follow-up. Pts with BM as first site of relapse consumed more healthcare resources compared to pts with secondary BM (38,813€/pt vs 32,253€/pt after one year of follow-up, respectively). Conclusions Healthcare resources spending is mainly concentrated at the beginning of metastatic disease management, especially for patients with BM as first site of relapse. These results illustrate the use of expensive treatments in the first months following BM diagnosis. Individual data derived from this observational study allowed us to gather more specifically treatment patterns for HER2+ BMBC in order to estimate the costs more accurately. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-02.

Revisión sistemática de los estudios de evaluación del coste de las reacciones adversas a medicamentos

ObjectiveAdverse drug reactions (ADRs) are an important healthcare problem. The objective of this study was to review published articles analyzing the cost of ADRs in any healthcare setting. MethodWe conducted a search of articles published on the cost of ADRs in the bibliographic databases from 1970 to 2010. We identified 28 studies and selected 16 that included cases of ADR fitting the World Health Organization's definition of these events. The information on the characteristics of the study design, the types of costs analyzed and the reported results were reviewed. ResultsThe design features and populations included in the studies were heterogeneous. Only two studies explicitly defined the perspective adopted. Only five studies compared cases of ADR with matched controls without ADRs. All studies analyzed direct healthcare costs, but none analyzed indirect or intangible costs. Fourteen publications analyzed the costs of length of hospital stay. The average (SD) percentage of ADRs was 3.04% (0.2) [median 2.4%, range 0.7% to 26.1%]. The median length of hospital stay in patients with ADRs was 8.8 days (range: 0.15 to 19.2 days). Accounting systems and monetary costs varied widely. ConclusionStudies on the costs of ADRs are highly heterogeneous and have evaluated direct healthcare costs in hospitals. Their results indicate that ADRs generate substantial costs. More studies using appropriate methodology are needed on the costs of ADRs.

PCN41 Hospital Health Care Costs for the Management of HER2-Positive Breast Cancer with Brain Metastases

PCN41 Hospital Health Care Costs for the Management of HER2-Positive Breast Cancer with Brain Metastases

Hospital Health Care Cost of Diarrheal Disease in Northern Ghana

Diarrhea caused by rotaviruses is one of the most frequent causes of hospitalization among pediatric patients in rural communities of developing countries in sub-Saharan Africa and Southeast Asia, and it is a major cause of death in these communities. The complexity of diarrhea and the increasing cost of treatment puts additional burden on the health sector. To demonstrate the economic burden of diarrhea to policy makers, this study was conducted to estimate the treatment cost of diarrhea in children <5 years old in Ghana using the World Health Organization protocol for cost data collection and estimation. The study was undertaken in Navrongo War Memorial Hospital in northern Ghana. Cost estimates were made for 3 treatment scenarios observed: (1) treatment by rehydration, (2) treatment by rehydration and antibiotics, and (3) treatment of diarrhea and other diseases. The average outpatient treatment costs for the 3 treatment scenarios were US$3.86, $4.10, and $4.35 respectively, and the average treatment costs for hospitalization (inpatient care) were $65.14, $97.40, and $133.86 respectively. The annual national treatment costs, based on the 3 treatment scenarios, ranged from $907,116 to $1,851,280 for outpatients clinic visits and from $701,833 to $4,581,213 for hospitalizations. The average length of stay for the inpatients ranged from 2.3 to 4.9 days. The study did not cover patient costs (ie, household costs).

Pushing Right against the Evidence: Turbulent Times for Canadian Health Care

Throughout the history of Canadian Medicare, there have been those who have opposed the universal, publicly funded system and advocated for greater private sector involvement. Amidst widespread public dissatisfaction with some aspects of Canadian health care--wait lists for some medical services, inadequate out-of-hospital drug coverage, and difficulties in accessing primary care--a series of recent events has shifted the public debate toward privately financed medicine, even as more Americans have been drawn toward universal public coverage. Certainly Canadian health care is in need of system reform. However, in a remarkably short time, the debate about the direction of reform has been transformed from one rooted in rigorous policy science, careful consideration of the empirical evidence, and an explicit commitment to universality, solidarity, equity, and the efficiencies of a single-payer, publicly-funded, not-for-profit system to one dominated by support for private and profit-driven systems and cut loose from solid evidence about what promotes equitable, effective, efficient, and sustainable health care. In fact, the move toward privatization rests on the repudiation of evidence-based health policy. Canadian Medicare provides publicly funded, tax-supported coverage for almost all doctor and hospital health care costs. This system developed gradually after World War II and was codified in the 1984 Canada Health Act, which calls for universality, accessibility, comprehensiveness, portability, and public administration of a not-for-profit system. It is crucial to understand that the CHA applies to the public funding (federal and provincial) of designated services, primarily hospital and doctor-delivered care. The delivery of health care has always been provided by a mixture of public and private--not-for-profit and for-profit--providers. Since the beginning of Medicare, doctors have typically been self-employed agents billing a fee fixed through negotiation between the provincial medical association and the provinces. The key to understanding the egalitarian nature of the Canadian health care system is that, while some providers are for-profit, they almost all bill the publicly funded insurance plan so that patients are not required to pay anything when they receive care. User fees, copays, and deductibles are banned for services covered under the public plan. While 70 percent of the total cost of health care is covered by public insurance, there has always been a strong role for private out-of-pocket and employer-based insurance for services not covered publicly, such as podiatry, dentistry, and nonsurgical vision care. All told, about 30 percent of total health care costs in Canada are covered privately. Although combining public and private funding is in line with practice in other OECD countries, the Canadian strategy is unique. In most countries, public funding is for standard level of care, and private funding for a preferential level of care for the same service. Canada alone makes public funding available for some services and relies on private funding for others. In addition, however, both patients and doctors are able to opt out of the public system, although the conditions for doing so vary from province to province. In most provinces, doctors cannot be paid privately for services for which they also bill the public system. Some provinces prohibit the sale of private insurance for services that are covered by the public system--a restriction intended to protect the integrity of the public insurance system. As health care has expanded in scope, and as much of the delivery of care has shifted to home and community, pressures have built on cost and access, just as they have across the entire developed world. Canada has launched various provincial and federal initiatives to reform the system, adapt it to contemporary practice, and ensure its sustainability. The most recent federal initiative was the Commission on the Future of Health Care in Canada, known as the Romanow Report after its author, the former premier of Saskatchewan, Roy Romanow. …

Prognostic Value of Normal Stress Myocardial Perfusion Imaging in Japanese Population A Study Based on the J-ACCESS Study

In Japan, Diagnosis Procedure Combination (DPC) of hospitalization health-care costs has been introduced since 2004, and its introduction has been recently expanded also to general hospitals. In such situations, the role of nuclear cardiology as a gatekeeper for the diagnosis of ischemic heart disease is increasingly important. Thus, the present study was designed to determine which clinical risk for hard events after normal single-photon emission computed tomography (SPECT) images, identify the predictors of increased risk in patients with normal SPECT images based on the J-ACCESS study. A total of 4,629 consecutively tested patients who underwent stress (99m)Tc-tetrofosmin SPECT at hospitals in Japan were included in the study. Based on SPECT image data, 1,862 participants had a summed stress score of <or=3, which was considered normal (selection criteria I; normal perfusion). Myocardial perfusion was normal in 46.2% of the study population. Among normal SPECT subjects, cardiac function, as assessed by quantitative gated SPECT software, showed 1,786 participants were considered normal, based on left ventricular end-systolic volume (ESV) (ESV <or=60 ml in men, ESV <or=40 ml in women), which is defined as selection criteria II (normal perfusion and ESV). In addition, 1,742 participants were found to be normal based on ejection fraction (EF) (EF >or=49% in men, EF >or=55% in women), which is defined as selection criteria III (normal perfusion, ESV and EF). During the 3-year follow-up period, there was a total of 211 cardiac events (11.3%) in patients grouped in selection criteria I, 196 cardiac events (11.0%) in patients grouped in selection criteria II, and 189 cardiac events in patients grouped in selection criteria III (10.8%). The annual hard event rates were 0.81%, 0.67% and 0.63% in selection criteria I, II and III, respectively. Cox proportional hazard analysis showed that diabetes mellitus, age and hypertension were independent predictors of all cardiac events in all selection criteria. Normal stress myocardial perfusion imaging in the Japanese population is associated with a low cardiac event risk. The prognosis results of a normal SPECT scan would be useful for better patient management.

EVIDENCE OF "ESSENTIAL UNCERTAINTY" IN EMERGENCY-WARD LENGTH OF STAY

Scaling in random time series is a novel way of gaining insight into mechanisms of complex systems. Scaling parameters characterize searches for the presence of "essential" uncertainty in outcomes of complex systems. The presence of this type of uncertainty in the emergency system (ES) can point to unusual ways of relieving the financial burden to the health system and improve the public health. The objective of this paper is to test for the presence of "essential" uncertainty in an outcome variable of the ES, i.e. emergency-ward length of stay (EWLS). An inverse power law (IPL) function fit to data can assess "essential" uncertainty. The study of EWLS has been undertaken in ten large Quebec hospitals. We find that all hospital EWLS are well fit by an IPL, as determined by an aggregated allometric relation. The presence of "essential" uncertainty is further confirmed by stratifying the EWLS according to proxies of disease complexity and severity at entry in emergency ward. Results point out that the various hospital dynamic systems embed "essential" uncertainty to various degrees. We conclude that intervention to reduce hospital health care costs must be centered on the interaction and feedback characterizing the ES processing of the patients.