Increased Health Care Costs Research Articles

Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units.

Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). OBJECTIVES: Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU). Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. SELECTION CRITERIA: Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined). newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs. Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures. the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both. The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used. We did not identify any published or ongoing trials to include in the review. The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.

Guidelines in Practice: Prevention of Perioperative Pressure Injury.

Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.

Patient Blood Management as an Emerging Concept in Quality: The Role of Nurses.

Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable. Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs. Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making. PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.

Health care cost of floods: Evidence from Typhoon Morakot in Taiwan

Using the difference-in-difference (DID) method, this study uses Typhoon Morakot, which occurred in August 2009, as an example to estimate the effect of flooding on health care cost burden. The main data source is the medical claims records of a cohort of three million patients in Taiwan’s National Health Insurance system. By examining flood-related physiological diseases and disaster-related mental illnesses, our results indicate that the increase in outpatient health care costs resulting from the flood caused by the typhoon is approximately NTD 8.95 billion (USD 280 million), equivalent to approximately 69% of the annual special budget for flooding prevention during the period 2006–2019 in Taiwan. Moreover, the increase in outpatient expenditure for mental illnesses is nearly 10 times that of physiological diseases. An important implication of our findings is that the cost of preventing natural disasters, such as floods, can be offset by saving health care costs, particularly for mental illnesses. Our results also suggest that in addition to providing safe drinking water and indoor residual spraying, offering continuous post-disaster mental health services can further save health care expenditures caused by natural disasters.

1011-P: Humanistic and Economic Burden of Patients with Cardiorenal Metabolic Conditions—A Systematic Literature Review

Background: A comprehensive understanding of the burden of CRM conditions is needed to guide targeted interventions. Objective: This SLR assessed the humanistic and economic burden of T2D, CVD (including HF), and CKD. Methods: Following PRISMA guidelines, Embase and Medline databases were systematically searched to identify observational, RWE, and economic-model studies in populations ≥18 years old with CKD, T2D, and CVD. Outcomes of interest included humanistic (e.g., health related QoL, functional impairment, QALY) and economic burden. English-language studies from Jan 2011 to Jan 2022 were included. Relevant abstracts/posters also were identified from ACC, AHA, ASN, and ADA from the 2 previous years. Results: Of 22 studies identified (13 US; 9 non-US) and included, 1 Chinese study reported QoL data (depressive symptoms of CKD and T2D), 8 reported healthcare resource utilization (HCRU), 7 reported cost, and 6 reported HCRU and cost. Multimorbidity and advanced stages of CKD were associated with higher medical costs and HCRU for patients with CRM across all studies. Increasing age was associated with more comorbidities, leading to greater economic burden among patients ≥65 years old. Higher costs and HCRU were observed in patients with all 3 conditions (T2D, CVD, CKD) compared to those with fewer comorbidities. Higher healthcare expenditures and HCRU was observed among urban insured compared with uninsured populations. Black patients had lower odds of using healthcare services compared to patients who identified as White, Asian/Pacific Islander, or Hispanic ethnicity. Conclusions: This SLR identified a clear trend of increasing healthcare costs and HCRU commensurate with an increasing number of CRM comorbidities. Further research evaluating the economic and humanistic burden of CRM conditions, especially in patients from racial/ethnic groups, is needed. Disclosure K.Ferdinand: Consultant; Amgen Inc., Boehringer Ingelheim Inc., Novartis, Medtronic, Pfizer Inc. K.C.Norris: None. H.W.Rodbard: Advisory Panel; Merck Sharp & Dohme Corp., Pacira BioSciences, Inc., Research Support; Eli Lilly and Company, Medtronic, Sanofi, Novo Nordisk. J.Trujillo: Advisory Panel; Novo Nordisk, Sanofi. Funding Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance

Increased healthcare costs in COVID-19 patients with unhealthy habits: The case of smoking.

This study aims to analyze the differences in the prognosis and cost of COVID-19 patients in terms of mortality and occurrence of complications due to tobacco use. This study was conducted using a unique Spanish electronic database built by health professionals during the first wave of the pandemic on the admission and evolution of a patient infected by the SARS-CoV-2 virus. Data were collected on all patients admitted to La Paz hospital (Madrid) from the pandemic's beginning until 15 July 2020. Demographic factors and the incidence of complications in smoker and non-smoker patients were compared using the Mann-Whitney U-test or chi-squared test. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. Finally, the costs between the two groups were estimated using a Generalized Linear Model. A total of 3521 patients were included in the analysis, with median age of 62 years (IQR: 47-78), 51.09% were women, and 16.42% were smokers. Patients who smoked had a higher incidence of complications during their hospital stay, especially complications related to the respiratory and cardiac systems. They were also associated with a worse prognosis in terms of the need for ICU admission and mortality, leading to an increase in the management cost of the smoking COVID-19 patients by 14.72%. Healthcare in Spain is mainly financed by the national tax system, so introducing an additional financing system for pathologies related to the consumption of addictive substances and associated diseases and complications would decrease the burden on the economy in terms of healthcare.

Inflammatory Markers or ‘Composite Index’ in COVID-19 as ‘Point Of Care Test’: Which One is the Best Choice to Tackle Dragon!

COVID-19 is first corona virus related global pandemic after SARS and MERS and due to rapid evolution of pandemic fast track developments in diagnostics, monitoring and treatment options and vaccine developments has occurred to prevent its significant impact on mortality and morbidity. COVID-19 infection involves a complex interplay of the immunological and inflammatory responses. Inflammatory parameters are closely linked to the COVID-19 severity and mortality. Inflammatory parameters could be used to predict the transition from mild to severe/critical infection in patients of COVID-19. Numerous Inflammatory markers were analysed and used as point of care test to predict severity of illness, monitoring of illness, treatment planning and predicting final outcomes such as CRP, LDH, IL-6, D-dimer and ferritin. Robust data of these inflammatory markers is available and proved crucial in predicting pathophysiological trends such as cytokine storm, coagulation abnormalities, oxygenation status and response to therapy. Isolated assessment of inflammatory markers in absence of clinical and radiological parameters were observed as ‘double edged weapon’ due to overestimation and its impact on health burden and underprediction resulting into progression of illness and resultant poor outcome and increased health care cost. Composite index is combination clinical, radiological and laboratory inflammatory marker assessment. Combination of any two abnormalities were observed crucial role in early suspicion, diagnosis, monitoring, and recognition of complications, management and disposition of patients. Composite index rather than single biomarkers may provide more reliable information. Availability and cost issues cannot be ignored. It would be impossible for clinicians to consolidate and critically analyse the enormous data that is continuously added to the COVID-19 literature to extract practically useful information for the benefit of patients. Still, as of now Composite index should be considered as ‘point of care test’ to honour successful treatment outcome and prevent mortality and morbidity due to this ‘Dragon Pandemic’.

O03 Penicillin and cephalosporin cross-reactivity: a single-centre UK study

Abstract Background Penicillin allergy (PenA) labels limit antimicrobial options, and concerns about cross-reactivity between penicillin and cephalosporins can further restrict prescribing. Alternative therapies are associated with reduced efficacy, poorer safety profiles and increased healthcare costs. Emerging literature suggests the incidence of cross-reactivity between penicillins and cephalosporins may be lower than historically reported rates of 2–10%. Furthermore, there is a lack of real-time data evaluating the percentage of patients with PenA who tolerate a cephalosporin. Objectives To determine the percentage of patients with a PenA label who tolerated cephalosporins in a secondary care setting. Methods Patients prescribed a cephalosporin from 01 January 2016 to 31 December 2020 at Leeds Teaching Hospitals NHS Trust (LTHT) were identified using the inpatient electronic prescribing system. 1613 with a PenA label were extracted for analysis. The team reviewed and clarified whether each patient (i) had a PenA label that was a potential hypersensitivity reaction, intolerance, or unknown/undocumented label and (ii) tolerated a cephalosporin. Tolerance was defined as receiving ≥1 dose without adverse effects or subsequent cephalosporin allergy label. We recorded if allergy or intolerance was a documented reason for stopping the cephalosporin. Results There were 1279 patients with a PenA label that received a cephalosporin. 555 (43%) had documentation in-keeping with a potential IgE-mediated allergic reaction to penicillins, 177 (14%) were deemed to have an intolerance and 547 (43%) had an unknown or undocumented label. 1263 (98.7%) patients tolerated a cephalosporin. Six (0.5%) patients stopped due to intolerance. One patient asked to stop therapy due to ‘changes’ in the skin. Nine (0.7%) patients developed possible allergic symptoms to cephalosporin; 4 patients developed a rash, 2 patients developed facial or lip swelling (without airway compromise), 1 patient developed hypotension, 1 patient developed difficulty breathing and 1 patient developed chest pain, breathlessness and itching. Of the 9 patients that had reactions; 5 had documented PenA labels that were classified as potential hypersensitivity reactions. Four patients had unknown or undocumented reactions to penicillins. Eight patients received a 2nd-generation cephalosporin (cefuroxime) and 1 received a 3rd generation (cefotaxime). Conclusions The rate of potential hypersensitivity reaction following administration of a cephalosporin in patients with any PenA label at LTHT was 0.7%. The incidence of cephalosporin allergy is estimated to be 1–3% of the general population (with/without PenA label). We conclude that, for patients with a history of unverified, non-anaphylactic PenA label, any cephalosporin could be administered without an increased risk of hypersensitivity reaction.

#3783 INCIDENCE AND PREDICTORS OF MAJOR ADVERSE KIDNEY EVENTS IN ICU PATIENTS WITH SEPSIS: A PROSPECTIVE COHORT STUDY FROM A DEVELOPING COUNTRY

Abstract Background and Aims Acute kidney injury (AKI) occurs in 15-60% of intensive care unit (ICU) admissions and is associated with higher mortality, morbidity and increased healthcare costs. Major adverse kidney events (MAKE) is a clinically meaningful patient-centred outcome for AKI which includes mortality, need for renal replacement (RRT) and persistent kidney dysfunction. There is a paucity of data on the incidence and risk factors of MAKE, particularly from developing countries. We sought to examine the incidence of MAKE at day 30 (MAKE30) and its predictors in a cohort of critically ill patients with sepsis. Method This was a prospective cohort study conducted in the medical ICUs of a tertiary-care hospital in India. Ethical clearance was obtained from the Institutional Ethics Committee. Adult patients (≥ 18 years) admitted in the medical ICUs between 1st September, 2022 and 31st December, 2022 with sepsis (as defined by Sepsis-3 criteria) were included. Those with chronic kidney disease stage 5/5D, those requiring dialysis within 72 hours of admission and with an ICU stay of <72 hours were excluded. Baseline clinical and demographic data were recorded on the day of admission. AKI was defined as per KDIGO 2012 guidelines. Patients were followed up till hospital discharge or day 30 (whichever was earlier) and clinical outcomes were noted. The primary outcome measure was MAKE30 (defined as a composite of death, provision of RRT, or sustained loss of kidney function i.e., a final inpatient creatinine ≥200% of the baseline value, at hospital discharge or at 30 days, whichever comes first). Results A total of 250 patients admitted in the medical ICUs during the study period were included for analysis. The baseline characteristics are tabulated below (Table 1). Over the 30-day follow-up period, AKI was noted in 185 (74%) patients, with stage 1 AKI in 38 (15.2%), stage 2 AKI in 29 (11.6%) and stage 3 AKI in 118 (47.2%). Renal replacement therapy was initiated in 86 (34.4%) patients. Mortality occurred in 58 (23.2%). Overall, MAKE30 was seen in 102 (40.8%) patients. Serum lactate (OR 1.04, 95% CI:1.01-1.06; P = 0.010) and SOFA score (OR 1.38, 95% CI:1.27-1.56; P <0.001) at admission were independently associated with MAKE30 (Table 2). There was no association with age, gender, diabetes, type of resuscitation fluid or cumulative fluid balance (at 72 hours) with MAKE30. Conclusion In this cohort of critically ill patients with sepsis, MAKE30 was observed in 40.8%. Serum lactate and SOFA score at admission were independent predictors of MAKE30.

Antibiotic Use for Febrile Children in a Tertiary Care Hospital's Outpatient Department: A Cross-Sectional Study.

Background Irrational prescription of antibiotics is contributing to the antimicrobial resistance crisis in low and middle-income countries. Antibiotic stewardship programs need to be implemented to rationalize the use of antibiotics, but data on antibiotic prescriptions in pediatric outpatient departments is minimal. This study aimed to determine the frequency of antibiotic prescriptions in febrile children attending the Paediatric Outpatient Department (OPD) at Combined Military Hospital, Lahore, and observe the factors affecting the decision to prescribe antibiotics. Methodology A cross-sectional, descriptive study with non-probability sampling in the Department of Paediatrics at the Combined Military Hospital (CMH), Lahore, was conducted over two years. The confidence limit was 95%, and the anticipated population proportion was 32%. The primary outcome was the proportion of children aged two months to 10 years presenting to the OPD with fever who received antibiotics. Further analysis included the effect of patient-level risk factors on antibiotic prescription, especially in children with respiratory tract infections (RTIs). Results Of the 225 children analyzed, 137 (61%) received antibiotics. Of these antibiotic prescriptions, 123 (90%) were second-line antibiotics. Older age (odds ratio (OR) = 2.3, 1.18-4.46), high fever (OR = 2.48, 1.37-4.5), presenting in autumn and winter seasons (OR = 2.85, 1.53-5.3), ill appearance (OR = 2.71, 1.12-6.55), tachycardia (OR = 4.28, 1.22-15.01), and tachypnea (OR = 4.01, 1.14-14.12) were associated with increased likelihood of antibiotic prescription. Antibiotic prescriptions in children with RTIs were associated with lower RTI (OR = 12.96, 3.49-48.08), probable bacterial infection (OR = 12.37, 4.77-30.05), tachycardia (OR = 10.88, 1.28-92.24), tachypnea (OR = 14.73, 3.14-68.99), and increased work of breathing (OR = 7.8, 2.05-29.56). Conclusions The evidence of the widespread inappropriate use of antibiotics in OPDs, particularly for upper RTIs, highlights the need for an antibiotic stewardship program. Antibiotic overprescription promotes antibiotic resistance, prolonging illness and increasing healthcare costs.

Raising awareness of recurrent cystitis among women

Background: Recurrent cystitis is a common condition affecting women, often causing discomfort and negatively impacting their quality of life. Despite the high level of morbidity, this condition is frequently overlooked due to relatively low fatality rate. This lack of adequate awareness about recurrent cystitis has led to increased healthcare costs, inappropriate utilization of medical resources, and growing antibiotic resistance. Therefore, there is an urgent need to raise awareness and improve the strategies employed for managing recurrent cystitis.Current Concepts: The socioeconomic burden imposed by recurrent cystitis is substantial, with billions of dollars spent worldwide every year on its diagnosis and treatment. Unnecessary emergency room visits and loss of labor due to illness further exacerbate the costs. Additionally, recurrent cystitis significantly diminishes patients’ quality of life, leading to psychological challenges such as anxiety and depression. Recent research has highlighted the importance of identifying underlying conditions and modifying lifestyle behaviors, in addition to actual treatment, to improve patients’ quality of life.Discussion and Conclusion: It is important to implement various strategies to raise awareness and foster interest in recurrent cystitis. These include patient education, public awareness campaigns, healthcare professional training, online resources, and research collaboration. By increasing awareness and adopting a proactive approach to managing recurrent cystitis, we can improve patient outcomes and enhance the overall efficiency of the healthcare system, ultimately benefiting patients, medical staff, and society as a whole.

Nurses’ education, knowledge and perceptions of peripheral intravenous catheter management: A web-based, cross-sectional survey

BackgroundPeripheral intravenous catheters (PIVCs) are the most used invasive medical device. Unfortunately, PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, infection, delays in treatment, increased healthcare costs, and even death. In Australia, qualified nurses assess, manage, and remove a PIVC as part of their clinical role. To date, no study has described the current state of knowledge and confidence (self-efficacy) about PIVCs from the perspectives of qualified nurses working in Australian hospital settings.AimsTo describe the current state of knowledge and confidence (self-efficacy) about PIVC management from the perspectives of qualified nurses working in Australian hospital settings. To explore how these related to the education received by these nurses.MethodsAn online cross-sectional survey.FindingsQualified nurses in Australia thought that education about PIVCs was important and that it should be underpinned by evidence-based guidelines. Knowledge Test score for the sample was 12.4/17 (SD 2.1), this equates to a mean grade of 73.0%. Respondents reported very high levels of confidence about caring for a patient with a PIVC in situ.ConclusionDespite the frequent and increasing use of PIVCs and importantly the documented adverse events associated with poor assessment, management and inappropriate removal, qualified nurses’ knowledge and confidence remain poorly reported. We demonstrated fundamental gaps in qualified nurses’ knowledge in relation to assessment, management, and removal of PIVCs.

Routine post-operative labs and healthcare system burden in acute appendicitis

BackgroundData from the National Health Expenditure Accounts have shown a steady increase in healthcare cost paralleled by availability of laboratory tests. Resource utilization is a top priority for reducing health care costs. We hypothesized that routine post-operative laboratory utilization unnecessarily increases costs and healthcare system burden in acute appendicitis (AA) management. MethodsA retrospective cohort of patients with uncomplicated AA 2016–2020 were identified. Clinical variables, demographics, lab usage, interventions, and costs were collected. ResultsA total of 3711 patients with uncomplicated AA were identified. Total costs of labs ($289,505, 99.56%) and repletions ($1287.63, 0.44%) were $290,792.63. Increased LOS was associated with lab utilization in multivariable modeling, increasing costs by $837,602 or 472.12 per patient. ConclusionsIn our patient population, post-operative labs resulted in increased costs without discernible impact on clinical course. Routine post-operative laboratory testing should be re-evaluated in patients with minimal comorbidities as this likely increases cost without adding value.

MEDICATION ADHERENCE AND GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS

Objective: One of the major clinical problems in the management of arterial hypertension (AH) is adherence to the medical regimen. Failure to adhere affects not only patients causing disease progression, reduced functional abilities as well as lower quality of life, but also the healthcare system due to medication waste and increased hospital visits and admissions. Data about hypertensive medication adherence in our region are lacking. Therefore, we aimed to assess medication adherence in our hypertensive patients in order to identify possible strategies to improve and enhance mentioned adherence. Design and method: This study included 324 participants with AH, of which 51.2 % were men, and with an overall median age of 64 years (IQR = 17). Along with the 24-hour ambulatory blood pressure measurement, each patient completed a medication adherence questionnaire, Morisky Medication Adherence Scale (MMAS-8). This self-reported questionnaire consists of 8 questions with a total score ranging from 0 to 8 and a lower score indicates lower adherence to the prescribed pharmacological antihypertensive therapy. Results: 51 (15.7%) participants had low, 114 (35.2%) had moderate and 159 (49.1%) had high medication adherence. There was no significant difference in MMAS-8 score regarding age (p = 0.334), however, men were found to have -higher adherence to antihypertensive therapy than women (58.5% vs. 41.5% had high adherence, respectively, p = 0.018). Conclusions: The results of our study showed that more than half of our hypertensive patients (50.9%) are not completely adherent to antihypertensive medication. Among all of them women were found to have lower adherence compared to men. Low medication adherence could lead to substantial worsening of disease as well as increased health care costs in care of hypertensive patients. Therefore, the presented results highlight the need for patient education and support to increase patient adherence in order to reduce cardiovascular risk.

Trends in Hospitalizations of Esophageal Varices From 2011 to 2018: A United States Nationwide Study.

Prevalence of gastroesophageal varices is around 50% of patients with cirrhosis. In compensated cirrhosis they are present in 30-40%. Progression from small to large varices occurs at rate of 10-12% annually. That percentage increases significantly in decompensated liver cirrhosis with gastroesophageal varices found in 85% of patients. Variceal hemorrhage occurs at a rate around 10-15% per year. The outcome of variceal hemorrhage depends on the severity of liver disease, size of varices, and presence of stigmata of recent bleeding (red whale sign). Six-week mortality of variceal hemorrhage ranges between 15% and 25%. Without treatment, variceal hemorrhage tends to recur in 60% of patients within 1 - 2 years. The aim of the study was to assess demographics of esophageal varices with and without bleeding, geographic distribution, comorbidities, outcomes, main payers, and cost of hospitalizations. The National Inpatient Sample (NIS) database from year 2011 to 2018 was used. Patients who had a primary diagnosis of esophageal varices with or without bleeding were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes (456.0 for esophageal varices with bleeding, and 456.1 for esophageal varices without bleeding), and International Classification of Diseases, 10th Revision (ICD-10) codes (I85.01 for esophageal varices with bleeding, and I85.00 for esophageal varices without bleeding) in the first two discharge diagnoses. The propensity score to calculate the inverse probability treatment weighting (IPTW) to adjust between the differences of the compared groups was implemented. Two groups were compared in terms of their hospitalization outcomes, including LOS, hospital charges, hospital mortality, and disposition. A total of 322,761 patients were admitted with esophageal varices between 2011 and 2018, with 236,802 (73.6%) had bleeding esophageal varices and 85,959 (26.4%) had nonbleeding esophageal varices. The majority of the patients from both groups were white (66%), covered with Medicare (38% in the esophageal varices with bleeding vs. 41% in the nonbleeding group). There was a steady increase of patients admitted with nonbleeding esophageal varices. Most common comorbidities were liver diseases, alcohol abuse, uncomplicated hypertension and depression in both groups. There were no significant changes in OLS over the years in both groups, but there was a significant increase in hospital charges, especially in the patients with bleeding esophageal varices starting in 2015, and no change in mortality throughout the years. Regarding hospital disposition, there was a notable decline in rehab discharge in the bleeding esophageal varices group. Esophageal varices with and without bleeding have been steadily increasing since the beginning of this century. This may result in a substantial impact on increasing health care costs and utilization due to acute variceal hemorrhage. Odds of death, transfer to urban hospital, and transfer to visiting nursing assistance remained unchanged.

EE343 The Effect of BMI and the Obesity Paradox on Post-PCI Healthcare Costs and Length of Stay

Coronary artery disease (CAD) is one of the leading causes of death, and 900,000 percutaneous coronary interventions (PCIs) are performed each year in the US. While BMI is known to affect PCI morbidity and mortality, overweight individuals have better outcomes compared to normal individuals in the obesity paradox phenomenon. Our study aimed to analyze whether this paradox translates to increases in healthcare costs and hospital length of stay (LOS) among adult post-PCI populations.

Impact on costs and outcomes of multi-gene panel testing for advanced solid malignancies: A cost consequence analysis using linked administrative data.

6650 Background: To date, economic analyses of tissue-based next generation sequencing genomic profiling (NGS) have required models with multiple assumptions, with little real-world evidence on overall survival (OS), clinical trial enrollment or end-of-life (EOL) quality of care. The OCTANE clinical trial (NCT02906943) is a prospective study evaluating the role of NGS for advanced solid tumors in Ontario, Canada. We performed a cost consequence analysis of OCTANE. Methods: We undertook a longitudinal, propensity score-matched retrospective cohort study using linked administrative data. OCTANE patients (pts) at Princess Margaret Cancer Centre from August 2016 until March 2019 undergoing NGS panel testing (555 or 163-gene panels) were matched with contemporary controls from across Ontario not enrolled in OCTANE. Patients were matched according to 19 variables including age, sex, place of residence, tumor site, symptom burden, income quintile, comorbidities and prior lines of systemic therapy. Primary outcomes were mean per capita health care costs (2019 Canadian dollars [CAD]) from the public payer’s perspective, OS, clinical trial enrollment and EOL quality metrics. Full 2-year follow-up data was available. Sensitivity analyses considered alternative matched cohort specifications. Results: There were 782 OCTANE pts with 782 matched controls. Variables were balanced after matching (standardized difference [std. diff.]<0.10). Most common tumor sites were: Ovary (30.4%), endometrium (15.0%) breast (12.3%) and colon (8.6%). OCTANE pts had higher mean healthcare costs than controls ($79,702 vs. $59,550), mainly due to costs of oncology visits ($33,165 vs. $26,197), outpatient clinic visits ($8,696 vs. $5,114) and emergency visits ($1,723 vs. $1,373) (all p<0.05). Publicly funded drug costs were less for OCTANE pts ($20,015 vs. $24,465). Overall, OCTANE enrollment was not associated with improved OS (restricted mean survival time (RMST) [standard error]: 1.50 (±0.03) vs. 1.44 (±0.03) years, log-rank p=0.153), but OCTANE was associated with longer OS in ovarian cancer (RMST: 1.69 (±0.05) vs. 1.45 (±0.06) years, p=0.011) and biliary tract tumors (RMST: 1.16 (±0.13) vs. 0.80 (±0.11) years, p=0.02). Importantly, OCTANE correlated with increased clinical trial enrollment (25.5% vs. 9.5%, p<0.001) and better EOL quality due to fewer deaths in hospital (10.2% vs 16.4%, p=0.003). Results were robust in sensitivity analysis. Conclusions: There was an increase in healthcare costs associated with NGS testing for advanced cancers. The impact on OS was not significant in the overall population, but varied across tumor types. OCTANE was associated with greater trial enrollment, lower publicly funded drug costs and fewer in hospital deaths suggesting important considerations in determining the value of NGS for advanced cancers. Clinical trial information: NCT02906943 .

EPH101 Medication Adherence in Egypt: A Systematic Review

Poor medication adherence is considered a significant healthcare issue leading to suboptimal health outcomes and increased healthcare costs, especially in developing countries. This systematic review systemized existing evidence in assessing medication adherence in the Egyptian population.

Pathology testing in non-trauma patients presenting to the emergency department with recurrent seizures.

Excessive pathology testing is associated with ED congestion, increased healthcare costs and adverse patient health outcomes. This study aimed to determine the frequency, yield and influence of pathology tests among patients presenting to the ED with atraumatic recurrent seizures. This was a retrospective cohort study conducted at a level 4 adult ED in Australia and included atraumatic patients presenting to ED with recurrent seizures over a 4-year period (2017-2020). The primary outcome was the frequency of pathology tests. Additionally, the proportion of abnormal pathology test results and the association between pathology tests and change in management were assessed. Of the 398 eligible presentations, 346 (86.9%, 95% confidence interval [CI] 83.3-89.9%) underwent at least one pathology test. In total 18.3% (n = 517) of pathology tests had an abnormal result which led to 15 changes in ED management among 12 presentations. Patients who had an abnormal pathology test result were more likely to undergo a change in antiepileptic drug management (odds ratio 2.08, 95% CI 1.23-3.65; P = 0.008). Most patients presenting to the ED with atraumatic recurrent seizures underwent pathology tests. Abnormalities were frequently detected but were uncommonly associated with change in management. Abnormal pathology test results were associated with changes in antiepileptic drug management although rarely led to acute changes in patient management. This study suggests that pathology tests may be excessively requested in this population.

A Clinico-Pathological Multidisciplinary Team Increases the Efficacy of Skin Biopsy and Reduces Clinical Risk in Dermatology.

A clinical risk is an inherent risk in healthcare processes, including skin biopsy procedures, and may lead to misdiagnoses, increased healthcare costs and potential harm to patients. Indeed, clinical and histopathological data must be integrated if we are to reduce clinical risks and improve diagnostic accuracy in the diagnosis of dermatologic diseases. Although dermopathology services used to be part of a dermatologist's duty, the recent centralization of these laboratories has caused a loss of expertise and increased both complexity and safety issues. Some countries have implemented clinical-pathological correlation programs aimed at facilitating communication between clinicians and dermatopathologists. However, Italy has regulatory and cultural barriers that make the implementation of these programs difficult. Therefore, an internal analysis was carried out to assess the efficacy and impact that skin biopsy procedures for inflammatory and neoplastic conditions have on the quality of care in our dermatology department. As the analysis evidenced a high number of descriptive pathologic reports and discordant diagnoses, a multidisciplinary group of four dermatologists, four general pathologists and one dermatopathologist was set up. Herein, we present the results of this analysis and project and describe the structure of the multidisciplinary group. We also discuss the pros and cons, possibilities and limitations of our project, including the regulatory barriers of the Italian National Health System.