Hospital Healthcare Costs Research Articles

Health Insurance – Opportunities and Challenges of Vietnamese Insurance Businesses

Nowadays, business operations are rapidly changing, demanding companies to constantly grasp market trends, utilize modern achievements in business, and have suitable business strategies and products to survive and thrive in the market. Insurance businesses in Vietnam are also following this trend. Under the development of the economy, politics, and society, the cost pressure on people's livelihoods is increasing. Particularly, healthcare costs in hospitals are a financial risk because not everyone has strong financial resources to cover accidents, illnesses, or diseases. Choosing health insurance is a priority for many people to protect their current and future financial risks. This presents an opportunity for insurance businesses to develop the market, assert their position in the insurance business market, increase revenue to survive amidst increasingly challenging business operations. However, the process of selling health insurance faces numerous difficulties and barriers such as consumer habits, intense competition, legal barriers, and more. Hence, there's a need for solutions to seize opportunities and overcome these challenges in developing health insurance products to aid the growth of insurance businesses. This article focuses on: (1) An overview of health insurance; (2) The current situation of health insurance business in Vietnamese insurance companies; (3) Identifying opportunities and challenges in selling health insurance products; (4) Proposing solutions to develop the business of health insurance products for insurance companies.

Hospital Health Care Costs Following Incident CKD in Japan, Sweden, and the United States

Hospital Health Care Costs Following Incident CKD in Japan, Sweden, and the United States

Mortality, Outcomes, Costs, and Use of Medicines Following a First Heart Failure Hospitalization: EVOLUTION HF

BackgroundThere are few contemporary data on outcomes, costs, and treatment following a hospitalization for heart failure (hHF) in epidemiologically representative cohorts. ObjectivesThis study sought to describe rehospitalizations, hospitalization costs, use of guideline-directed medical therapy (GDMT) (renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors), and mortality after hHF. MethodsEVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational, longitudinal cohort study using data from electronic health records or claims data sources in Japan, Sweden, the United Kingdom, and the United States. Adults with a first hHF discharge between 2018 and 2022 were included. The 1-year event rates per 100 patient-years (ERs) for death and rehospitalizations (with a primary diagnosis of heart failure (HF), chronic kidney disease [CKD], myocardial infarction, stroke, or peripheral artery disease) were calculated. Hospital health care costs were cumulatively summarized. Cumulative GDMT use was assessed using Kaplan-Meier estimates. ResultsOf 263,525 patients, 28% died within the first year post-hHF (ER: 28.4 [95% CI: 27.0-29.9]). Rehospitalizations were mainly driven by HF (ER: 13.6 [95% CI: 9.8-17.4]) and CKD (ER: 4.5 [95% CI: 3.6-5.3]), whereas the ERs for myocardial infarction, stroke, and peripheral artery disease were lower. Health care costs were predominantly driven by HF and CKD. Between 2020 and 2022, use of renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists changed little, whereas uptake of sodium-glucose cotransporter-2 inhibitors increased 2- to 7-fold. ConclusionsIncident post-hHF rehospitalization risks and costs were high, and GDMT use changed little in the year following discharge, highlighting the need to consider earlier and greater implementation of GDMT to manage risks and reduce costs.

End of Life Cost Savings in the Palliative Care Unit Compared to Other Services.

Hospital deaths carry a significant healthcare cost that has been confirmed to be lower when palliative care units (PCUs) are available. To compare the last admission hospital health care cost of dying in a first-level hospital between the PCU and the rest of the hospital services. A retrospective, comparative, observational study evaluating costs from the payer perspective on treatments and diagnostic-therapeutic tests performed on patients who die in first-level hospital, comparing whether they were treated by the PCU or another unit (Non-PCU). Patients with a mortality risk >2 were included according to the Severity of Illness Index (SOI) and Risk of Mortality (MOR). All cost express in €, median per patient and interquartile range (IQR). From 1,833 patients who died, 1,389 were included, 442 (31.1%) treated by PCU and 928 (68.9%) Non-PCU. Statistical differences were found for the last admission total cost (€262.8 (€470.1) for PCU versus €515.3 (€980.48) in Non-PCU), daily total cost (€74.27 (€127.4) vs €115.8 (€142.4) Non-PCU). Savings were maintained when the sample was broken down by diagnosis-related group (DRG) and a multivariate analysis was performed to determine how the different patients baseline characteristics between PCU and Non-PCU patients influenced the results obtained. Data from this study show that cost is significantly lower when the patients are treated by a PCU during their last hospital stay when they pass away.

113 Prevention, Diagnosis, and Management of Fracture Related Infections in Accordance with the BOA FRI Guidelines

Abstract Aim Fracture related infections (FRI) are common and serious complications of musculoskeletal trauma. With average hospital health care costs for infected patients being 6.5 times higher than uninfected patients, FRI poses a significant social-economic burden to the patient and healthcare system. We aim to audit current practice in preventing and diagnosing FRIs and improve management of infections in patients with fractures. The guidelines covered are the British Orthopaedic Association (BOA) FRI guidelines. Method Our sample included patients who suffered an infection as a direct consequence of fracture and/or subsequent surgical management procedures over a seven-year period. Surgical procedures were performed for fractures in 8826 patients. In total, 102 patients with an FRI were reviewed. Audit results and recommendations have been presented at a clinical governance meeting. Results Seven out of sixteen items had poor compliance (<80% compliance). Ultrasound-guided aspiration was done in 21.6% (22/102), even if debridement surgery is delayed. 1.96% (2/102) received adequate advice about responding to a suspected FRI. 56.9% had recommended 2-week antibiotic-free duration before sampling. Our recommendations include pre-written template in discharge documentation providing guidance on responding to a suspected FRI, better communication between microbiology, surgical team, and GPs regarding antibiotic prescription timing, including weekly bone and joint infection MDT review for FRI patients. Conclusions Lowering FRI-related burden requires a three-pronged approach: uniform set of standards for infection prevention in trauma and orthopaedic surgery, robust diagnostic workup for suspected FRI cases, effective management scheme for confirmed FRI cases. These systems should be a key element of orthopaedic trauma service.

SP5.1.4 Prevention, Diagnosis, and Management of Fracture Related Infections in accordance with the BOA FRI Guidelines

Abstract Aim Fracture related infections (FRI) are common and serious complications of musculoskeletal trauma. With average hospital health care costs for infected patients being 6.5 times higher than uninfected patients, FRI poses a significant social-economic burden to the patient and healthcare system. We aim to audit current practice in preventing and diagnosing FRIs, and improve management of infections in patients with fractures. The guidelines covered are the British Orthopaedic Association (BOA) FRI guidelines. Method Our sample included patients who suffered an infection as a direct consequence of fracture and/or subsequent surgical management procedures over a seven-year period. Surgical procedures were performed for fractures in 8826 patients. In total, 102 patients with a FRI were reviewed. Audit results and recommendations have been presented at a clinical governance meeting. Results Seven out of sixteen items had poor compliance (<80% compliance). Ultrasound-guided aspiration was done in 21.6% (22/102), even if debridement surgery is delayed. 1.96% (2/102) received adequate advice about responding to a suspected FRI. 56.9% had recommended 2-week antibiotic-free duration before sampling. Our recommendations include pre-written template in discharge documentation providing guidance on responding to a suspected FRI, better communication between microbiology, surgical team, and GPs regarding antibiotic prescription timing, including weekly bone and joint infection MDT review for FRI patients. Conclusions Lowering FRI-related burden requires a three-pronged approach: uniform set of standards for infection prevention in trauma and orthopaedic surgery, robust diagnostic workup for suspected FRI cases, effective management scheme for confirmed FRI cases. These systems should be a key element of orthopaedic trauma service.

Cost of healthcare utilization associated with incident cardiovascular and renal disease in individuals with type 2 diabetes: A multinational, observational study across 12 countries.

AimTo examine how the development of cardiovascular and renal disease (CVRD) translates to hospital healthcare costs in individuals with type 2 diabetes (T2D) initially free from CVRD.MethodsData were obtained from the digital healthcare systems of 12 nations using a prespecified protocol. A fixed country‐specific index date of 1 January was chosen to secure sufficient cohort disease history and maximal follow‐up, varying between each nation from 2006 to 2017. At index, all individuals were free from any diagnoses of CVRD (including heart failure [HF], chronic kidney disease [CKD], coronary ischaemic disease, stroke, myocardial infarction [MI], or peripheral artery disease [PAD]). Outcomes during follow‐up were hospital visits for CKD, HF, MI, stroke, and PAD. Hospital healthcare costs obtained from six countries, representing 68% of the total study population, were cumulatively summarized for CVRD events occurring during follow‐up.ResultsIn total, 1.2 million CVRD‐free individuals with T2D were identified and followed for 4.5 years (mean), that is, 4.9 million patient‐years. The proportion of individuals indexed before 2010 was 18% (n = 207 137); 2010‐2015, 31% (361 175); and after 2015, 52% (609 095). Overall, 184 420 (15.7%) developed CVRD, of which cardiorenal disease was most frequently the first disease to develop (59.7%), consisting of 23.0% HF and 36.7% CKD, and more common than stroke (16.9%), MI (13.7%), and PAD (9.7%). The total cumulative cost for CVRD was US$1 billion, of which 59.0% was attributed to cardiorenal disease, 3‐, 5‐, and 6‐fold times greater than the costs for stroke, MI, and PAD, respectively.ConclusionAcross all nations, HF or CKD was the most frequent CVRD manifestation to develop in a low‐risk population with T2D, accounting for the highest proportion of hospital healthcare costs. These novel findings highlight the importance of cardiorenal awareness when planning healthcare.

Hospital healthcare costs attributable to heat and future estimations in the context of climate change in Perth, Western Australia

Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.

Health care costs among adolescent young adults with cancer at a community-based hospital.

e18857 Background: Adolescent Young Adults (AYAs) are likely to live for decades after a cancer diagnosis and thus have the potential to accumulate high healthcare costs. Prior research has shown high costs can be associated with increased risk of morbidity and mortality. However, there is limited understanding of how costs impact AYAs, especially in a community hospital. The purpose of this study is to 1) understand total community hospital healthcare costs for AYA patients with cancer, 2) identify risk factors for high costs, and 3) assess the impact of costs on survival. Methods: AYA patients (ages 15-29) treated at a community hospital were identified. Data collected included patient demographics, cancer characteristics, treatments (chemotherapy, radiation, surgery, immunotherapy, hormone therapy), support services (financial counseling, social work, survivorship), hospital admissions, miles from the hospital (great-circle distance), and all healthcare charges from one year prior to cancer diagnosis until last follow-up between 2000-2020. Multivariate logistic regression analyses were used to identify patients with costs greater than the median ($125K). Cox Proportional Hazard (CPH) regression models were used to identify factors associated with the risk of all-cause mortality. Results: A total of 388 AYA patients were identified with a median follow-up of 9 years and 97% survival. Most patients were age 30-39 years (62%), female (61%), white (95%), married (63%), non-smoker (59%), had insurance (78%), had early-stage cancer (85%), and were treated with surgery (83%). The most common cancers were melanoma (17%), breast cancer (14%), and thyroid cancer (14%). Median distance from treatment site was 23 miles. Median number of admissions was one. About a third of patients received chemotherapy (37%), radiation (28%), or hormone therapy (30%). Two-hundred thirty-three patients (60%) had complete healthcare cost data with a median total costs per patient of $123K (range, $73K-$215K). In adjusted analysis, patients with higher than median healthcare cost ( > $125K) had greater odds of hospital admission (odds ratio [OR] = 1.5, p < .001) and chemotherapy treatment (OR = 3.4, p = .005) as well as lower odds of living further from the hospital per one mile (OR = 0.3, p = .049) and being uninsured/unknown insurance (OR = 0.1, p = .047). In adjusted analysis, increased risk of death was associated with receiving radiation therapy (HR = 7.8, p = .02) and higher healthcare costs per $125K (HR = 3.8, p = .001). Conclusions: High costs of healthcare among AYA patients with cancer are related to chemotherapy, hospital admissions, and hospital proximity. High healthcare costs and radiation therapy may be associated with increased risk of death in the AYA population. This data may guide physician decision making for AYA patients ensuring mindfulness of high costs of care and how it relates to poor survival outcomes in community hospitals.

Substance use during pregnancy: impact on Colorado community hospital

BackgroundNeonatal Abstinence Syndrome (NAS) leads to increased length of stay (LOS), which leads to increased healthcare costs, and can cause financial burdens for hospitals. The purpose of the study was to determine the impact of substance use by pregnant women on a Colorado (CO) community hospital after state legalization of recreational cannabis.MethodsData were gathered retrospectively through the electronic health record at an inpatient facility and described 607 mothers and 419 newborns (total N = 1026) who tested positive for drugs (urinalysis or blood for mother and urine, meconium, or cord blood for newborns). Screening for drugs was at discretion of healthcare provider if mother reported use or newborn showed symptoms of NAS. The patients who were not screened or tested negative were excluded from consideration. Newborns exposed to cannabis were compared to those exposed to other drugs (opioids, methadone, cocaine, barbiturates, benzodiazepines, amphetamines) on costs of newborn hospitalization, based on type of newborn bed and length of stay (LOS). Group comparisons were done using Cochran-Armitage chi-square tests and two-sample t-tests.ResultsThe proportion of screened patients testing positive for illicit and prescribed substances increased significantly from 2013 (33.4%) to 2017 (50.2%) (p < 0.001). The LOS of drug-exposed newborns increased significantly over the years (p < 0.0001). Newborns testing positive for cannabis were more likely to remain in a normal newborn nursery (NSY) bed (69.8%) than those testing positive for other drugs (27.7%), with an average hospital LOS (4.6 days) significantly shorter (p < 0.001) than that of other-drug exposed newborns (14.2 days). Combined healthcare costs for other-drug exposed newborns ($23,495,221) were significantly higher (p < 0.001) than for cannabis-exposed newborns ($2,885,139); both groups had significantly higher costs (p < 0.001) than normal healthy newborns ($2,166,649).ConclusionDrug-exposed newborns have a significant financial impact on hospital healthcare costs, largely due to more expensive bed placement and longer LOS.

Clinical and financial burden of hospitalised community-acquired pneumonia in patients with selected underlying comorbidities in England

BackgroundHospitalised pneumonia may have long-term clinical and financial impact in adult patients with underlying comorbidities.MethodsWe conducted a retrospective cohort study using the Hospital Episode Statistics (HES) database to determine the...

Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Erythematosus.

Treat-to-target end points for systemic lupus erythematosus (SLE) have been assessed for their impact on damage accrual and flare, but whether they have an impact on the high health care utilization and costs in SLE has not been studied. The purpose of this study was to examine our hypothesis that the recently described lupus low disease activity state (LLDAS) would be associated with reduced health care cost. Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K], physician global assessment [PhGA], and flare index), and medication use were evaluated, and direct health care utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI-2K ≤4 with no new activity, PhGA ≤1, prednisolone ≤7.5 mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Two hundred SLE patients, contributing 357.8 person-years of observation, were included. A history of lupus nephritis was present in 42% of patients, and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index >0) was present at study commencement in 57.3% of patients. The mean ± SD annual direct medical cost per patient was US$7,413 ± 13,133/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase; P = 0.009) and corticosteroid use (>7.5-15 mg/day: 55.7% increase; P = 0.02; and >15 mg/day: 202% increase; P < 0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (P = 0.04). Greater time spent in LLDAS was associated with significantly reduced direct hospital health care costs among patients with SLE.

HEALTH CARE ASSOCIATED URINARY TRACT INFECTIONS IN DEPARTMENT OF MEDICINE

Introduction: Health care associated infections (HCAIs) or hospital acquired infections (HAIs) are infections that occur during hospitalization but they are neither present nor incubating before hospital admission. Health care–associated urinary tract infection (UTI) is an important cause of morbidity and increased health care costs in hospitals. Rapid advances in medical field, injudicious use of antibiotics and better adaptation of organisms to the hospital environment contribute to increase in HAIs. There are additional patient safety concerns associated with urinary catheter insertion, like patient discomfort, activity restriction, discharge delays, and the potential development of a reservoir of multidrug-resistant organisms that can be spread to other patient. &#x0D; Material and Methods: Patients admitted in wards of medicine department were included in the present study. Patients who were admitted for at least for past 48 hours, or readmitted in less than 14 days after their discharge from hospital. Sociodemographic data from all the included patients was collected from medical records. Clinical history was obtained from all the patients. Signs of HAI were observed and recorded. Bacteremia was defined as presence of bacteria in the blood confirmed by at least one positive blood culture.&#x0D; Results: A total of 238 patients were included in the study who were admitted in the medicine wards. Out of 238 patients included in the study, 31 (13.02%) presented one or several signs suggestive of HAI and they received microbiological tests. 20 (8.40%) cases were confirmed or potential HAI. Of the 238 patients 109 (54.20%) were male and 129 (45.79%) were female. 31 patients were diagnosed as HAI patients of which 14 (45.16%) were male and 17 (54.83%) were female. Mean age of HAI patients was 54.21 ± 17.41while total mean of age was 46.52 ± 16.74. Mean age of male with HAI 52.41 ± 19.53 and female was 53.46 ± 16.77. Of the total 7 culture positive patients with HAI Escherichia coli was isolated in 3 cases, Klebsiella pneumonia in 2 caesa, Pseudomonas aeruginosa and Staphylococcus aureus were isolated in 1 cases each. Conclusion: Prevalence of HAI in Urinary tract infection was 13.02% in this study. Preventive measures, periodic active surveillance over a longer period is required to reduce the rate of healthcare associated UTI.&#x0D; Keywords: UTI, HAI, Health care associated infections, Catheter-associated UTI

A Comparative Cost-Effectiveness Analysis of Percutaneous Transluminal Angioplasty With Optional Stenting and Femoropopliteal Bypass Surgery for Medium-Length TASC II B and C Femoropopliteal Lesions

Purpose: To evaluate the total midterm costs and cost-effectiveness of percutaneous transluminal angioplasty with optional stenting (PTA/S) as initial treatment compared with femoropopliteal bypass (FPB) surgery in patients with medium-length TransAtlantic Inter-Society Consensus II (TASC) B and C femoropopliteal lesions. Materials and Methods: Over a period of 3 years, all hospital health care costs for 226 consecutive patients were calculated: 170 patients with a TASC B lesion and 56 patients with a TASC C lesion. In the 135-patient PTA/S group (mean age 69.9±10.9 years; 83 men), 108 (63.5%) patients had TASC B lesions and 27 (48.2%) patients had TASC C lesions. Ninety-one patients (mean age 68.4±10.9 years; 60 men) were treated with FPB for 62 TASC B and 29 TASC C femoropopliteal lesions. The main outcome measure was the primary patency rate at 3-year follow-up. Multiple imputation and bootstrapping techniques were used to analyze the data. The adjusted incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in total costs by the difference in 3-year primary patency rate. Costs were expressed in euros (€), and cost differences are presented with the 95% confidence interval (CI). Results: Mean total costs per patient were €29,058 in the PTA/S treatment group vs €42,437 in the FPB group (mean adjusted difference –€14,820, 95% CI –€29,044 to −€5976). Differences in 3-year primary patency between PTA/S and FPB were small and nonsignificant (68.9% and 70.3%, respectively). An ICER of 563,716 was found, indicating that FPB costs €563,716 more per one extra patient reaching 3-year primary patency in comparison with PTA/S treatment. Conclusion: FPB in medium-length femoropopliteal lesions involved higher total costs when evaluated over a 3-year follow-up period. An endovascular-first approach is recommended, as this will result in cost minimization for patients with medium-length femoropopliteal disease.

PCN259 - A REAL-WORLD DATA STUDY REGARDING HOSPITAL RESOURCES USE AND COSTS ASSOCIATED WITH MELANOMA CANCER IN SPAIN

To identify patients with melanoma cancer who visited hospital during 2016 and to describe hospital resources used and costs associated through a healthcare claim database. Retrospective information from the Ambulatory and Patientś Hospitalization database 2016 (6.5 million inhabitants as reference population) of the Spanish Minimum Basic Data Set (MBDS) were used. All hospital contacts of patients who had at least one diagnosis for melanoma cancer (coded C43 using ICD-10) were collected. Socio-demographic information (age, sex), number of hospital contacts (hospitalization and outpatient care), length of stay (days), main diagnoses and procedures performed during hospitalization and outpatient care, and costs were extracted. A total of 842 patients with melanoma cancer were identified: 53.9% women, mean age (standard deviation (SD)) 61.8 (18.0). A total of 134 hospitalization episodes (5 most frequent main diagnoses: 11.9% C43.59, 8.2% C79.31, 3.7% C43.9, 3.7% C43.72, 3.7% C43.71) and 2,590 outpatient episodes were observed (5 most frequent main diagnoses: 33.1% C43.9, 9.5% Z51.11, 9.5% Z51.12, 8.1% F39, 3.7% C43.59). A total of 11 (1.3%) patients died during a hospital episode. Length of hospitalization for the overall sample was estimated in 1,183 days and the total hospital healthcare costs were €2.5 million. A patient has a mean of 0.2 hospitalization episodes, 1.4 hospitalization days, and 3.1 outpatient visits, with a total cost of €2,993 that includes €870 and €2,123 for inpatient and outpatient care, respectively. Real-world data studies provides useful information regarding hospital resource use for a range of diseases where patients have a regular contact with hospital. Melanoma cancer patients caused an important use of health resources and associated costs for hospitals in Spain.

PCN271 - A REAL-WORLD DATA STUDY REGARDING HOSPITAL RESOURCES USE AND COSTS ASSOCIATED WITH BREAST CANCER IN SPAIN

To identify patients with breast cancer who visited hospital during 2016 and to describe hospital resources used and costs associated through a healthcare claim database. Retrospective information from the Ambulatory and Patientś Hospitalization database 2016 (6.5 million inhabitants as reference population) of the Spanish Minimum Basic Data Set (MBDS) were used. All hospital contacts of patients who had at least one diagnosis for breast cancer (coded C50 using ICD-10) were collected. Socio-demographic information (age, sex), number of hospital contacts (hospitalization and outpatient care), length of stay (days), main diagnoses and procedures performed during hospitalization and outpatient care, and costs were extracted. A total of 4,468 patients with breast cancer were identified: 99.4% women, mean age (standard deviation (SD)) 59.1 (13.5). A total of 1,268 hospitalization episodes (5 most frequent main diagnoses: 8.6% C50.912, 8.1% C50.911, 5.8% C50.412, 4.9% C50.812 and 4.0% C50.411) and 34,307 outpatient episodes were observed (5 most frequent main diagnoses: 42.0% Z51.11, 30.6% C50.919, 9.9% Z51.12, 1.9% C50.911 and 1.5% C50.912). A total of 69 (1.5%) patients died during a hospital episode. Length of hospitalization for the overall sample was estimated in 7,236 days and the total hospital healthcare costs were € 27.8 million. A patient has a mean of 0.28 hospitalization episodes, 1.6 hospitalization days, and 7.7 outpatient visits, with a total cost of €6,218 that includes €1,347 and €4,871 for inpatient and outpatient care, respectively. Real-world data studies provide useful information regarding hospital resource use for a range of diseases where patients have a regular contact with hospital. Breast cancer patients visit a hospital approximately 8 times per year causing associated costs for hospitals in Spain.

PCN263 - A REAL-WORLD DATA STUDY REGARDING HOSPITAL RESOURCES USE AND COSTS ASSOCIATED WITH PROSTATE CANCER IN SPAIN.

To identify patients with prostate cancer who visited hospital during 2016 and to describe hospital resources used and costs associated through a healthcare claim database. Retrospective information from the Ambulatory and Patientś Hospitalization database 2016 (6.5 million inhabitants as reference population) of the Spanish Minimum Basic Data Set (MBDS) were used. All hospital contacts of patients who had at least one diagnosis for prostate cancer (coded C61 using ICD-10) were collected. Socio-demographic information (age, sex), number of hospital contacts (hospitalization and outpatient care), length of stay (days), main diagnoses and procedures performed during hospitalization and outpatient care, and costs were extracted. A total of 2,243 patients with prostate cancer were identified: 99.8% men, mean age (standard deviation (SD)) 72.0 (10.0). A total of 1,180 hospitalization episodes (5 most frequent main diagnoses: 27.8% C61, 4.7% N39.0, 3.6% I50.9, 3.0% J18.9 and 2.0% A41.9) and 5.898 outpatient episodes were observed (5 most frequent main diagnoses: 40.5% C61, 28.3% Z51.11, 2.7% Z51.12, 2.4% Z51.0 and 1.7% D46.9). A total of 90 (4.0%) patients died during a hospital episode. Length of hospitalization for the overall sample was estimated in 9,482 days and the total hospital healthcare costs were € 10 million. A patient has a mean of 0.5 hospitalization episodes, 4.2 hospitalization days and 2.6 outpatient visits, with a total cost of €4,472 that includes €2,746 and €1,726 for inpatient and outpatient care, respectively. Real-world data studies provide useful information regarding hospital resource use for a range of diseases where patients have a regular contact with hospital. Prostate cancer patients visit a hospital approximately 3 times per year at hospital causing associated costs for hospitals in Spain.

A randomised controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty: long-term follow-up.

To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium cranioplasty or autologous bone graft following decompressive craniectomy. Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had cranioplasty failure or associated complications such as seizures beyond 1year-with a minimum of 24-month follow-up. Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete cranioplasty failure at 12months follow-up and there had been no failures beyond 12months. Amongst the 31 patients who had an autologous cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12months presented 1year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24months, use of titanium instead of autologous bone for primary cranioplasty resulted in a significant reduction in the number of patients who required rescue cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1-42.1%; p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231-17,768; p = 0.015). Bone resorption continued to occur beyond 12months after autologous cranioplasty; use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.

Use of health resources and healthcare costs associated with nutritional risk: The FRADEA study

In spite of its high prevalence and its clinical relevance, the economic impact of malnutrition has not been sufficiently explored. To study whether malnutrition predicts total hospital healthcare costs and costs related to specialist visits, emergency department visits and hospitalization in older adults. Concurrent cohort study in Albacete City, Spain. The study sample included 827 subjects aged 70 and over from the FRADEA Study. Mini Nutritional Assessment®-Short Form (MNA®-SF) was recorded at baseline. Use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs were recorded at follow-up. Generalized linear models (GLM) adjusted for age, sex, comorbidity, polypharmacy, and disability in basic activities of daily living were used to estimate the impact of nutritional factors on total healthcare costs per person/year (€ base year 2013) as well as specialist visit costs, emergency department visit costs and hospitalization costs. The average cost associated with the use of health resources was 1922€/year. Subjects with MNA®-SF between 0 and 7 had an average total health cost of 3492€/year, 2744€/year in those with MNA®-SF between 8 and 11, and 1542€/year in those with MNA®-SF between 12 and 14. Of the total health cost, 67.2% was associated with hospital admission costs. Adjusted healthcare costs were 714€/year greater in subjects with malnutrition or nutritional risk. Subjects with malnutrition or nutritional risk presented an increased adjusted risk of hospitalization (OR1.72, 95% CI 1.22-2.43). Malnutrition assessed by MNA®-SF is a prognostic factor of high healthcare cost and use of resources in older adults.

Healthcare Platform and Big Data Analysis Based Personal Fitness Healthcare Service Model

Human beings are living longer these days thanks to developments in medical technology and health care services, and accordingly, the global population is rapidly aging. The increasing aging generation is causing unexpected social problems, one of the most critical of which is government health care costs. Personal gene analysis results and record-based personal health care ICT services should predict and prevent personal diseases while improving wellness. Technically, gene sequencing technology development not only reduces the time to decode genetic information but also decreases the cost. Various disease-related gene mutations have been found, and gene sequencing service is a new paradigm in personal health care. In socioeconomic terms, the proposed service model not only accurately diagnoses diseases to provide effective health care but also reduces government health care costs while promoting personal well-being. In this paper, we propose a PGAR (personal gene analysis record) and PHR (personal health care record)-based personal health care service. We implemented this big data analysis-based health care platform for more accurate disease prediction and prevention. When the personal smart health care ICT service is used, it significantly reduces personal health care costs in hospitals.