Inpatient Claims Research Articles

S2701 Economic Costs and Trends in Inflammatory Bowel Disease-Related Hospitalizations and Surgery in the United States

Introduction: Limited data are available on hospitalization, surgery, and cost trends over time in patients with Crohn’s disease (CD) and ulcerative colitis (UC) in the United States. This analysis describes real-world trends in hospitalizations, surgery, and costs among patients with CD and UC. Case Description/Methods: Data from patients with CD and UC in the IBM MarketScan Databases (2007–2019) were evaluated. Eligible patients for each year had to have ≥1 inpatient claim or 2 outpatient claims for either CD or UC within that year and medical benefits for the entire year. For hospitalizations, an encounter group algorithm for all inpatient claims was utilized to determine the principal diagnosis and duration of each hospital episode. The surgery encounter was defined as either a hospitalization with a CD/UC-related surgery procedure code (principal procedure type) with a CD or UC diagnosis code in the first 2 diagnosis positions of the hospital encounter or an outpatient visit. Proportions of CD and UC patients with ≥1 hospitalization or surgery, the average cost per surgery or hospitalization episode, and mean length of stay (LOS) in days were reported for each year. Costs were adjusted to 2020 US dollars. Over time, prevalence of hospitalizations decreased from 11.8% and 7.7% in 2007 to 7.1% and 4.8% in 2019 in patients with CD and UC, respectively ( Figurea). The annual proportion of patients with a CD/UC-related surgery decreased from 2.3% and 1.2% in 2007 to 1.6% and 0.9% in 2019 in patients with CD and UC, respectively. Conversely, mean medical costs per CD/UC hospitalization episode increased from $22,346/$23,002 in 2007 to $28,586/$28,069 in 2019 (Figureb). Additionally, mean medical costs per CD/UC surgery increased from $41,300 and $47,286 in 2007 to $55,870 and $61,698 in 2019. In patients with CD and UC, the average LOS per hospitalization reduced from 5.8 and 6.6 days in 2007 to 4.6 and 5.6 days in 2019. Discussion: Despite a decrease in CD- and UC-related hospitalizations and surgery from 2007 to 2019, as well as reduced mean LOS, the average cost per hospitalization and surgery increased. Additional research is warranted to better understand these trends so that medical costs can be further reduced and management of patients in the outpatient setting can be improved.Figure 1.: Prevalence of (a) Hospitalization and Surgery and (b) Mean Costs by Year *Includes all associated costs except medication costs. CD, Crohn’s disease; K, thousand; UC, ulcerative colitis.

Mortality, Health Care Use, and Costs of Clostridioides difficile Infections in Older Adults.

Estimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death. Retrospective observational claims analysis. Patients aged ≥65years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods. Using 100% Medicare Fee-for-Service claims data for 2009-2017, primary (pCDI, n= 345,893) and recurrent (rCDI: n= 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12months before and up to 12months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities. CDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR)= 1.83, P < .001; rCDI: OR= 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR= 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI:+3.2days, P < .001; rCDI:+2.6days, P < .001), and higher total cost (pCDI:+303%, P < .001; rCDI:+297%, P < .001). CDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden.

Real-world versus clinical trial CAR T outcomes among patients diagnosed with diffuse large B-cell lymphoma.

413 Background: Chimeric antigen receptor (CAR) T cell therapy is a high-value innovative therapy for patients diagnosed with diffuse large B cell lymphoma (LBCL). The Federal Drug Administration (FDA) has approved three CAR T-cell therapies for these patients: axicabtagene ciloleucel, tisagenlecleucel and liso-cel. Data on real-world survival and adverse events (AEs) among Medicare beneficiaries receiving CAR T is limited. This study aims to compare real-world CAR T outcomes to clinical trial results. Methods: Retrospective cohort analysis using CMS 100% Medicare Fee-for-Service (FFS) Inpatient (Part A) and Outpatient (Part B) claim files. The database contains information on inpatient and outpatient diagnoses based on the International Classification of Diseases 10th Revision-Clinical Modification (ICD-10-CM). Inpatient files were used to identify Medicare FFS beneficiaries with LBCL diagnosis (ICD-10-CM code C83.3) who received inpatient CAR T procedure between January 2020 and March 2021. Demographic characteristics (age &amp; sex), 12-month survival, and AEs were identified and compared to outcomes from three CAR T clinical trials (tisagenlecleucel: JULIET; axicabtagene ciloleucel (axi-cel): ZUMA-1; and lisocabtagene maraleucel (liso-cel): TRANSCEND NHL 001). Results: The real-world cohort (RW pts) consisted of 463 Medicare FFS beneficiaries with LBCL who were administered CAR T cell therapy inpatient between January 2020 and March 2021. A higher proportion of RW pts were aged 65 or older compared to clinical trial patients, and a lower proportion of RW pts were male (57% vs 65%). Overall, fewer RW pts experienced cytokine release syndrome (CRS) and anaemia compared to patients across the clinical trials (Table). Other common AEs, including neutropenia, fatigue, and thrombocytopenia, occurred at lower rates among RW pts compared to rates in the axicabtagene ciloleucel and liso-cel clinical trials. Survival at 12-months was comparable between RW pts and clinical trial patients. Conclusions: Study findings suggest that real-world occurrence of common AEs following inpatient CAR T administration, including CRS and anaemia, are lower compared to clinical trial outcomes. Real-world evidence of CAR T is critical for understanding real-world benefit, safety, and value of novel therapies.[Table: see text]

Impact économique des comorbidités dans l’arthroplastie totale de cheville et l’arthrodèse de cheville

BackgroundThe demand for total ankle arthroplasty (TAA) and ankle arthrodesis surgery is increasing. Findings from other orthopaedic populations suggest an increasing comorbidity burden among those planned for surgery, however, data on TAA and ankle arthrodesis is limited. The goal of this study is to study the comorbidity burden for TAA and ankle arthrodesis. HypothesisComorbidity burden is associated with higher resource utilization for both TAA and ankle arthrodesis. Patients and methodsThis retrospective cohort study utilized data from the nationwide Premier Healthcare Database (2006–2016) which contains inpatient claims on n=10,085 ankle arthrodesis and n=4977 TAA procedures. Patients were categorized into Deyo-Charlson comorbidity index (DCCI) groups. Outcomes were cost of hospitalization, length of stay (LOS), total opioid utilization, discharge to a skilled nursing facility (SNF), and 30-day readmission. Mixed-effects models estimated associations between DCCI and outcomes. We report odds ratios (OR, or % change for continuous outcomes) and 95% confidence intervals (CI). ResultsIn the TAA group, 67.9% of patients were in DCCI category 0 while 22.4%, 6.6%, and 3.1% were in the 1, 2, and>2 DCCI categories, respectively. This was 61.3%, 18.1%, 9.8% and 10.9% in the ankle arthrodesis group. The most common comorbidities were obesity, diabetes mellitus, and chronic pulmonary disease. Particularly in the ankle arthrodesis group, the proportion of patients with comorbidities has increased over time. After adjustment for relevant covariates, patients in the DCCI group>2 (compared to ‘0′) were associated with stepwise effects of up to 77.1% (CI 70.9%; 83.6%) longer length of stay and up to 48.5% (CI 44.0%; 53.2%) higher cost of hospitalization. DiscussionsComorbidity burden is increasing among patients undergoing ankle arthrodesis where it is associated with significantly increased resource utilization. Our data demonstrate the potential impact of patient selection, which may be crucial in optimizing preoperative status. Level of evidenceIII.

Incidence of venous thromboembolism in patients with peripheral arterial disease after endovascular intervention

ObjectiveVenous thromboembolism (VTE) is a well-known postoperative complication; however, the incidence of VTE after peripheral vascular intervention (PVI) has not been well described. Despite the minimally invasive nature of these procedures, the patients undergoing PVI have significant risk factors for the development of VTE. In the present study, our objective was to describe the short-term incidence of VTE after PVI, identify differences between sexes, and examine the periprocedural antiplatelet and anticoagulation regimens. MethodsWe identified adults (age >66 years) who had undergone PVI from January 1, 2008 to September 30, 2015 from the inpatient Medicare claims data. The patients were followed for 365 days after the procedure. VTE events during follow-up were identified using the International Classification of Diseases, 9th revision, diagnosis codes. The covariate-standardized 30- and 90-day cumulative incidence of VTE events, overall and stratified by sex, were estimated using Aalen-Johansen estimators, accounting for death as a competing risk. Differences in sex between females and males were identified using Gray’s test. Any antiplatelet or anticoagulant prescription fill was defined as any fill from 14 days before the endovascular intervention through the date of the VTE event. Persistence with antiplatelet and anticoagulant therapy was assessed by creating daily logs of antiplatelet and anticoagulant coverage using the dispensing dates and days of supply. Over-the-counter medications (ie, aspirin) were not evaluated. ResultsWe identified 31,593 qualifying patients with a mean age of 76.8 ± 7.4 years. Of the 31,593 patients, 46% were male, and 12% had a history of VTE. After the procedure, deep vein thrombosis (DVT) was a commonly diagnosed complication (3.8% and 4.8% at 30 and 90 days, respectively). The cumulative incidence of pulmonary embolism was 0.9% and 1.2% at 30 and 90 days after the procedure, respectively. Throughout the 90-day postoperative period, females had had a slightly increased risk of DVT compared with males (30-day risk difference, 0.007; P < .01; 90-day risk difference, 0.008; P = .02). We found no sex-based differences in the risk of pulmonary embolism. Of the patients who had developed VTE at 90 days, 970 (55%) had had no prescription fill for an antiplatelet or anticoagulant. Assuming all the patients had been taking aspirin, only 15% of the patients who had developed VTE had been taking prescribed dual antiplatelet medication persistently after PVI. In addition, among the patients who had developed VTE at 90 days, females were less likely to have had a prescription fill for an anticoagulant. ConclusionsThe findings from our study have demonstrated that the incidence of VTE after PVI is high, with an increased risk of deep vein thrombosis for females. We also found that females were less likely to have been prescribed an anticoagulant after PVI. Future studies are needed to characterize the variables associated with an increased risk of VTE after PVI and to identify strategies to increase dual antiplatelet therapy or anticoagulant prescription adherence to reduce the risk of VTE.

The risk of COVID-19 in patients with psoriasis: A retrospective cohort study

To the Editor: Clinical trials and real-world data generally suggest that biologics do not increase susceptibility to COVID-19.1 However, it remains unknown whether these therapies may confer a protective effect against contracting COVID-19. Therefore, we sought to assess the risk of COVID-19 infection in patients with psoriasis compared with the general population and in patients receiving systemic and topical therapies. This study used the Symphony Health dataset, a large repository of pharmacy data, inpatient and outpatient medical claims, and remittance data (over 300 million patients, 7 million COVID-19 cases, and payer information: Medicaid/Medicare/commercial/cash).

Analysis of Pending Claims Due to Incompatibility of Diagnostic and Action Codes in Inpatients in Hospitals

This research was conducted at UNS Sukoharjo Hospital. Based on the preliminary study, it was found that 19.5% of the claims filed were pending in inpatient claims and 31% were due to coding cases. This study was conducted to determine pending claims due to coding discrepancies in hospitalized National Health Insurance patients.&#x0D; This is a case study research type with a qualitative research design. Data were taken by observation and interviews with the head of the medical record installation room, coding officer, head of the guarantee installation room, and the verifier of the Health Insurance Administration. The data collected, presented descriptively, and analyzed using content analysis techniques.&#x0D; The results showed that the coding of claim files had been carried out according to hospital standards. Submission of the claim file is carried out after verification by the internal verifier. The pending claim occurs due to a mismatch in coding caused by the need for a join code, an error in determining the main diagnosis, the need for confirmation of the action code, and the need for confirmation of supporting reports. Other influencing factors are support from colleagues, technology support, limited knowledge, and lack of staff training, as well as system changes and problematic servers both from hospitals and from Health Insurance Providers.&#x0D; The conclusion is that there are still pending claims caused by coding cases, so it is better for officers to take coding training and perform server maintenance.

Causes of Dispute for COVID-19 Outpatient and Inpatient Claims at the Muhammadiyah University General Hospital of Malang

Muhammadiyah University General Hospital of Malang is a COVID-19 referral hospital for Malang. Between April 2020 and June 2021, the hospital submitted 62 outpatient and 1364 inpatient cases for COVID-19 claims to the Ministry of Health of the Republic of Indonesia. The percentage of outpatient dispute claims was 25% and of inpatient dispute claims was 39%. These disputed claims disturbed the cash flow of the health facilities. The aim of our study was to describe the causes of outpatient and inpatient COVID-19 dispute claims. Our methodology was descriptive, and the secondary data were taken from claim submission documents. There were ten criteria that caused dispute claims based on KMK Number HK. 01.07/MENKES/4718/2021. This was related to administrative and medical issues. The most common cause of inpatient dispute claims (35%) was that the criteria for discharge from the hospital were not in accordance with the guarantee limit. Additionally, the most common cause of outpatient dispute claims (60%) was the management of isolation that was not related to the guidelines for management and prevention of COVID-19.&#x0D; Keywords: claim dispute criteria, hospital, COVID-19

Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 2 Diabetes.

To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes. Claims data from 100% of Medicare beneficiaries enrolled in fee-for-service plans from 2006 to 2017 were analyzed. Records with type 2 diabetes and complications were identified using ICD-9, ICD-10, and diagnosis-related group codes. The index year was the year when a person was first identified as having diabetes with an inpatient claim or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars. Our study included 10,982,900 beneficiaries with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplant (occurring year $79,045, subsequent years $17,303), kidney failure treated by dialysis ($54,394, $38,670), and lower-extremity amputation ($38,982, $8,084). Congestive heart failure accounted for the largest share (18%) of total complication costs. Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment and programs to prevent and delay diabetes complications in Medicare beneficiaries.

Mitral Regurgitation and Mortality Risk in Medicare Beneficiaries With Heart Failure and Preserved Ejection Fraction

The association of mitral regurgitation (MR) severity and mortality in heart failure with preserved ejection fraction (HFpEF) is uncertain. We sought to evaluate the relation between MR severity on transthoracic echocardiography (TTE) and subsequent all-cause mortality in Medicare beneficiaries with HFpEF. We linked 57,608 patients referred for TTE at Beth Israel Deaconess Medical Center to Medicare inpatient claims from 2003 to 2017. In those with a history of HF and a physician-reported left ventricular ejection fraction ≥50%, we evaluated the relation of MR severity and time to the primary end point of all-cause mortality using Kaplan-Meier methods. A total of 7,778 individuals (14.5%) met inclusion criteria (mean age 75.5 years ± 11.9, 55.9% female). Over a median follow-up of 8.1 years, 2,016 (25.9%) died at a median (interquartile range) of 1.7 (0.3 to 4.1) years. At 1 year, 15.8% with 3 to 4+ MR had died versus 10.5% with 0 to 2+ MR (hazard ratio 1.54, 95% confidence interval 1.22 to 1.95, p <0.001). After multivariable adjustment, 3 to 4+ MR continued to be associated with increased all-cause mortality (hazard ratio 1.48, 95% confidence interval 1.14 to 1.94, p=0.004) except in the subset with atrial fibrillation (interaction p=0.03) or recent (<3 months) HF hospitalization (p=0.54). In conclusion, in this large, single-institution retrospective study of Medicare beneficiaries with HFpEF who underwent TTE, moderate-to-severe and severe MR were significantly associated with an increased risk of all-cause mortality after multivariable adjustment, except in those with atrial fibrillation or recent HF. Prospective studies are needed to assess the role of MR reduction in mitigating this risk.

Association of Insurance Mix and Diagnostic Coding Practices in New York State Hospitals

Given higher reimbursement rates, hospitals primarily serving privately insured patients may invest more in intensive coding than hospitals serving publicly insured patients. This may lead these hospitals to code more diagnoses for all patients. To estimate whether, for the same Medicaid enrollee with multiple hospitalizations, a hospital's share of privately insured patients is associated with the number of diagnoses on claims. This cross-sectional study used patient-level fixed effects regression models on inpatient Medicaid claims from Medicaid enrollees with at least 2 admissions in at least 2 different hospitals in New York State between 2010 and 2017. Analyses were conducted from 2019 to 2021. The annual share of privately insured patients at the admitting hospital. Number of diagnostic codes per admission. Probability of diagnoses being from a list of conditions shown to be intensely coded in response to payment incentives. This analysis included 1 614 630 hospitalizations for Medicaid-insured patients (mean [SD] age, 48.2 [20.1] years; 829 684 [51.4%] women and 784 946 [48.6%] men). Overall, 74 998 were Asian (4.6%), 462 259 Black (28.6%), 375 591 Hispanic (23.3%), 486 313 White (30.1%), 128 896 unknown (8.0%), and 86 573 other (5.4%). When the same patient was seen in a hospital with a higher share of privately insured patients, more diagnoses were recorded (0.03 diagnoses per percentage point [pp] increase in share of privately insured; 95% CI, 0.02-0.05; P < .001). Patients discharged from hospitals in the bottom quartile of privately insured patient share received 1.37 more diagnoses when they were subsequently discharged from hospitals in the top quartile, relative to patients whose admissions were both in the bottom quartile (95% CI, 1.21-1.53; P < .001). Those going from hospitals in the top quartile to the bottom had 1.67 fewer diagnoses (95% CI, -1.84 to -1.50; P < .001). Diagnoses in hospitals with a higher private payer share were more likely to be for conditions sensitive to payment incentives (0.08 pp increase for each pp increase in private share; 95% CI, 0.06-0.10; P < .001). These findings were replicated in 2016 to 2017 data. In this cross-sectional study of Medicaid enrollees, admission to a hospital with a higher private payer share was associated with more diagnoses on Medicaid claims. This suggests payment policy may drive differential investments in infrastructure to document diagnoses. This may create a feedback loop that exacerbates resource inequity.

Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012-2018.

Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children < 15 years of age, pneumococcal pneumonia-related hospitalisations decreased from 35 to 13 per 100,000 person-years during the study period (p < 0.001); this decrease is potentially related to PCV use in children. All-cause pneumonia hospitalisations remained stable, whereas IPD hospitalisations increased and AOM hospitalisations decreased. In adults, hospitalisations for all-cause pneumonia increased from 5.00 to 7.50 per 1000 person-years (+50%; p < 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those ≥ 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy.

COVID-19 and Hospitalization Among Maintenance Dialysis Patients: A Retrospective Cohort Study Using Time-Dependent Modeling

Rationale & ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on hospitalizations in general and on dialysis patients in particular. This study modeled the impact of COVID-19 on hospitalizations of dialysis patients in 2020.Study DesignRetrospective cohort study.Setting & ParticipantsMedicare patients on dialysis in calendar year 2020.PredictorsCOVID-19 status was divided into 4 stages: COVID1 (first 10 days after initial diagnosis), COVID2 (extends until the Post-COVID stage), Post-COVID (after 21 days with no COVID-19 diagnosis), and Late-COVID (begins after a hospitalization with a COVID-19 diagnosis); demographic and clinical characteristics; and dialysis facilities.OutcomeThe sequence of hospitalization events.Analytical ApproachA proportional rate model with a nonparametric baseline rate function of calendar time on the study population.ResultsA total of 509,609 patients were included in the study, 63,521 were observed to have a SARS-CoV-2 infection, 34,375 became Post-COVID, and 1,900 became Late-COVID. Compared with No-COVID, all 4 stages had significantly greater adjusted risks of hospitalizations with relative rates of 18.50 (95% CI, 18.19-18.81) for COVID1, 2.03 (95% CI, 1.99-2.08) for COVID2, 1.37 (95% CI, 1.35-1.40) for Post-COVID, and 2.00 (95% CI, 1.89-2.11) for Late-COVID.LimitationsFor Medicare Advantage patients, we only had inpatient claim information. The analysis was based on data from the year 2020, and the effects may have changed due to vaccinations, new treatments, and new variants. The COVID-19 effects may be somewhat overestimated due to missing information on patients with few or no symptoms and possible delay in COVID-19 diagnosis.ConclusionsWe discovered a marked time dependence in the effect of COVID-19 on hospitalization of dialysis patients, beginning with an extremely high risk for a relatively short period, with more moderate but continuing elevated risks later, and never returning to the No-COVID level.

114. Surgeon volume is associated with complications after lumbar fusion

114. Surgeon volume is associated with complications after lumbar fusion

P-003: EVALUATION OF TREATMENT PATTERN, HEALTHCARE RESOURCE UTILIZATION AND COSTS OF ILLNESS FOR SICKLE CELL DISEASE IN GHANA: A PRIVATE MEDICAL INSURANCE CLAIMS DATABASE STUDY

Purpose: Sickle cell disease (SCD) is a group of inherited red cell disorders associated with substantial clinical and economic burden. Sub-Saharan Africa accounts for nearly 75% of the global burden of SCD. However, inequities in access to healthcare, including novel therapeutic options, absence of standard treatment guidelines, few dedicated SCD treatment centers and the high cost of treatment have made the management of SCD a challenging task in the region. The current study assessed treatment patterns and healthcare resource utilization (HCRU) and costs in patients with SCD using data from a national Private Medical Insurance database. Materials and methods: Claims data from Ghana’s Nationwide Medical Insurance Database were analyzed between January 1, 2015 and March 31, 2021. Patients with at least 12 months of follow-up data for ≥1 SCD diagnosis claim during the index period (July 1, 2015 to March 31, 2020) and continuous enrollment for at least one claim during the 6-months baseline period prior to index date and 12-months follow-up period post-index date, were included in the study. Healthcare resource utilization and associated costs for patients with SCD were assessed for outpatient and inpatient visits, medications, consumables (medical/surgical supplies) procedures (medical/surgical procedures, diagnostic investigations), services (consultation/hospital services) and other activities (administrative services) during the 12-month follow-up period. Results: Claims data for 2,863 identified patients with SCD (mean age: 20.1 ± 16.0 years; 43.9% males, 56.1% females) were considered. The cohort was stratified by age into two groups: pediatric (<16 years) and adult (≥16 years). The most common complications across all age groups included malaria, upper respiratory tract infection, sepsis, acute chest syndrome, and cellulitis. Most patients were prescribed non-steroidal anti-inflammatory drugs (75.6%), anti-infectives (52.2%), haematinics (27.9%), anti-malarials (26.5%), and opioid analgesics (9.7%), while standard-of-care hydroxyurea was prescribed to only 0.3% of patients. The mean time to first hospitalization was 129.9 ± 107.8 days, and the annual rate of hospitalization was 1.7 ± 1.4 during the 12-month follow-up period. Outpatient claims were higher compared to inpatient claims (2.2 ± 2.4 vs. 1.7 ± 1.4). Most claims pertained to medications (1.9 ± 1.8) and services (2.2 ± 2.3). Costs incurred for inpatient claims were higher compared to outpatient claims (United States Dollar [USD] 261.4 ± 460.5 vs. 56.6 ± 60.4) (Figure 1) during the 12-month follow up period. This was mainly attributed to medications (USD 40.0 ± 117.2) and services (USD 43.3 ± 114.0) (Table 1). Conclusion: To our knowledge, this is the first cost-of-illness study conducted to evaluate HCRU for patients with SCD in Ghana. Our findings suggest that SCD has a substantial impact on healthcare costs in Ghana, consistent with the results of other studies evaluating the economic burden of SCD. Based on our results, use of hydroxyurea therapy as standard of care for SCD management was suboptimal for this cohort of patients. There is an opportunity to increase access to hydroxyurea and other emerging therapies to manage SCD and associated complications, and to reduce the economic burden of the disease.Source for conversion of Cedi to USD currency:https://www.unitconverters.net/currency/ghs-to-usd.htm; Accessed on 21Feb2022 1 Cedi=0.1515234164.Procedures examples: diagnostic investigations, surgical procedures. Services examples: specialist consultation, hospital services. Consumables examples: Oxygen cannula, dressings, syringes, needles, catheters, gloves etc C. SEGBEFIA declares a conflict of interest: Consultancy, Expert: Novartis Steering Committee/Advisory Board Global Blood Therapeutics - DSMB K. MARFO declares a conflict of interest: Stock shareholder: Novartis Other: Novartis employee O. EGBUJO declares a conflict of interest: Stock shareholder: Novartis Shareholder Other: Novartis Employee K. ATAGA declares a conflict of interest: Consultancy, Expert: Novartis, Global Blood Therapeutics, Pfizer, Forma Therapeutics, Agios Pharmaceutics, Novo Nordisk Invitation to national or international congresses: N/A Patent or product inventor: N/A Research support/Scientific studies: Novartis, Global Blood Therapeutics, Forma Therapeutics Stock shareholder: N/A Trainings, Teaching: Novo Nordisk, Novartis

Variation of ventral and incisional hernia repairs in kidney transplant recipients.

As survivorship following kidney transplant continues to improve, so does the probability of intervening on common surgical conditions, such as ventral or incisional hernia, in this population. Ventral hernia management is known to vary across institutions and this variation has an impact on patient outcomes. We sought to evaluate hospital level variation of ventral or incisional hernia repair (VIHR) in the kidney transplant population. We performed a retrospective review of 100% inpatient Medicare claims to identify patients who underwent kidney transplant between 2007 and 2018. The primary outcome was 1- and 3-year ventral or incisional risk- and reliability-adjusted VIHR rates. Patient and hospital characteristics were evaluated across risk- and reliability-adjusted VIHR rate tertiles. Models were adjusted for age, sex, race, and Elixhauser comorbidities. Overall, 139,741 patients underwent kidney transplant during the study period with a mean age (SD) of 51.6 (13.7) years. 84,717 (60.6%) were male, and 72,657 (52.0%) were white. Median follow up time was 5.4years. 2098 (1.50%) patients underwent VIHR. the 1year risk- and reliability-adjusted hernia repair rates were 0.49% (95% Conf idence Interval (CI) 0.48-0.51, range 0.31-0.59) in tertile 1, 0.63% (95% CI 0.62-0.63, range 0.59-0.68) in tertile 2, and 0.98 (95% CI 0.91-1.05, range 0.68-2.94) in tertile 3. Accordingly, compared to hospitals in tertile 1, the odds of post-transplant hernia repair tertile 2 hospitals were 1.78 (95% CI 1.37-2.31) and at tertile 3 hospitals 3.53 (95% CI 2.87-4.33). In a large cohort of Medicare patients undergoing kidney transplant, the overall cumulative incidence of hernia repair varied substantially across hospital tertiles. Patient and hospital characteristics varied across tertile, most notably in diabetes and obesity. Future research is needed to understand if program and surgeon level factors are contributing to the observed variation in treatment of this common disease.

Burden of chemotherapy in patients with relapsed/refractory acute myeloid leukemia in the United States: a retrospective claims database study

ABSTRACT Background Real-world estimates of relapsed or refractory (R/R) acute myeloid leukemia (AML) chemotherapy episode costs are scarce. We quantified chemotherapy episode–related costs and healthcare resource use (HRU) in R/R AML. Research Design and Methods This real-world, retrospective analysis of United States claims from IQVIA’s PharMetrics® Plus database (October 2008-September 2019) identified adults with R/R AML and ≥1 chemotherapy episode. Chemotherapy episode (ie, low- [LIC] or high-intensity [HIC] chemotherapy) costs and HRU were determined using inpatient, outpatient, and pharmacy claims. Results Mean (SD) and median total all-cause healthcare costs per R/R AML chemotherapy episode were $230,799 ($300,770) and $129,117. Mean (SD) and median adjusted direct R/R AML chemotherapy episode costs were $116,384 ($151,425) and $63,298, with increases noted from the first to the second and subsequent episodes and with HIC. Hospitalizations were the major cost driver; 64.1% of patients had ≥1 hospitalization and 36% required an intensive care unit stay. Conclusions R/R AML chemotherapy episode costs were high, with higher costs reported with HIC and increasing lines of chemotherapy. Hospitalizations were a main cost driver. Novel therapies with comparable or improved effectiveness and decreased need for hospitalizations versus chemotherapy may help alleviate the clinical and economic burden of R/R AML.

Social Disparities in Outpatient and Inpatient Management of Pediatric Supracondylar Humerus Fractures.

Socioeconomic status, race, and insurance status are known factors affecting adult orthopaedic surgery care, but little is known about the influence of socioeconomic factors on pediatric orthopaedic care. The purpose of this study was to determine if demographic and socioeconomic related factors were associated with surgical management of pediatric supracondylar humerus fractures (SCHFs) in the inpatient versus outpatient setting. Pediatric patients (<13 years) who underwent surgery for SCHFs were identified in the New York Statewide Planning and Research Cooperative System database from 2009–2017. Inpatient and outpatient claims were identified by International Classification of Diseases-9-Clinical Modification (CM) and ICD-10-CM SCHF diagnosis codes. Claims were then filtered by ICD-9-CM, ICD-10-Procedural Classification System, or Current Procedural Terminology codes to isolate SCHF patients who underwent surgical intervention. Multivariable logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having inpatient management versus outpatient management. A total of 7079 patients were included in the analysis with 4595 (64.9%) receiving inpatient treatment and 2484 (35.1%) receiving outpatient treatment. The logistic regression showed Hispanic (OR: 2.386, p < 0.0001), Asian (OR: 2.159, p < 0.0001) and African American (OR: 2.095, p < 0.0001) patients to have increased odds of inpatient treatment relative to White patients. Injury diagnosis on a weekend had increased odds of inpatient management (OR: 1.863, p = 0.0002). Higher social deprivation was also associated with increased odds of inpatient treatment (OR: 1.004, p < 0.0001). There are disparities among race and socioeconomic status in the surgical setting of SCHF management. Physicians and facilities should be aware of these disparities to optimize patient experience and to allow for equal access to care.

Development of a Novel Prospective Model to Predict Unplanned 90-Day Readmissions After Total Hip Arthroplasty

BackgroundFor hospitals participating in bundled payment programs, unplanned readmissions after surgery are often termed “bundle busters.” The aim of this study was to develop the framework for a prospective model to predict 90-day unplanned readmissions after elective primary total hip arthroplasty (THA) at a macroscopic hospital-based level. MethodsA national, all-payer, inpatient claims and cost accounting database was used. A mixed-effect logistic regression model measuring the association of unplanned 90-day readmissions with a number of patient-level and hospital-level characteristics was constructed. ResultsUsing 427,809 unique inpatient THA encounters, 77 significant risk factors across 5 domains (ie, comorbidities, demographics, surgical history, active medications, and intraoperative factors) were identified. The highest frequency domain was comorbidities (64/100) with malignancies (odds ratio [OR] 2.26), disorders of the respiratory system (OR 1.75), epilepsy (OR 1.5), and psychotic disorders (OR 1.5), being the most predictive. Other notable risk factors identified by the model were the use of opioid analgesics (OR 7.3), Medicaid coverage (OR 1.8), antidepressants (OR 1.6), and blood-related medications (OR 1.6). The model produced an area under the curve of 0.715. ConclusionWe developed a novel model to predict unplanned 90-day readmissions after elective primary THA. Fifteen percent of the risk factors are potentially modifiable such as use of tranexamic acid, spinal anesthesia, and opioid medications. Given the complexity of the factors involved, hospital systems with vested interest should consider incorporating some of the findings from this study in the form of electronic medical records predictive analytics tools to offer clinicians with real-time actionable data.

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

The sex differences in use, safety outcomes, and health-care resource use of patients with pulmonary embolism (PE) undergoing percutaneous pulmonary artery thrombectomy are not well characterized. What are the sex differences in outcomes for patients diagnosed with PE who undergo percutaneous pulmonary artery thrombectomy? This retrospective cross-sectional study used national inpatient claims data to identify patients in the United States with a discharge diagnosis of PE who underwent percutaneous thrombectomy between January 2016 and December 2018. We evaluated the demographics, comorbidities, safety outcomes (in-hospital mortality), and health-care resource use (discharge to home, length of stay, and hospital charges) of patients with PE undergoing percutaneous thrombectomy. Among 1,128,904 patients with a diagnosis of PE between 2016 and 2018, 5,160 patients (0.5%) underwent percutaneous pulmonary artery thrombectomy. When compared with male patients, female patients showed higher procedural bleeding (16.9%vs11.2%; P< .05), required more blood transfusions (11.9%vs5.7%; P< .05), and experienced more vascular complications (5.0%vs1.5%; P< .05). Women experienced higher in-hospital mortality (16.9%vs9.3%; adjusted OR, 1.9; 95%CI, 1.2-3.0; P= .003) when compared with men. Although length of stay and hospital charges were similar to those of men, women were less likely to be discharged home after surviving hospitalization (47.9%vs60.3%; adjusted OR, 0.7; 95%CI, 0.50-0.99; P= .04). In this large nationwide cohort, women with PE who underwent percutaneous thrombectomy showed higher morbidity and in-hospital mortality compared with men.