Medical Costs For Patients Research Articles

#3429 HIGHER INPATIENT COSTS FOR HEMODIALYSIS PATIENTS HOSPITALIZED FOR CEREBROVASCULAR DISEASE

Abstract Background and Aims Dialysis patients often have comorbidities that result in frequent hospitalizations. Several studies showed that inpatient costs contributed largely to the medical costs of dialysis patients. In this study, to assess the impact of comorbidities on inpatient costs in dialysis patients, we examined the association between reasons for admission and the inpatient costs using electronic medical records. Method This was a single-center, retrospective, observational study of dialysis patients admitted to Yokohama General Hospital (300 beds) between April 2020 and March 2022. Information on patient demographics, cause of end-stage kidney disease (ESKD), dialysis duration, number of complications, and reasons for admission were collected from electronic medical records. Inpatient costs were calculated from claims data and analyzed based on patient characteristics and reasons for admission. Inpatient costs for dialysis patients were compared with those for all hospitalized patients. Data were analyzed using the Kruskal-Wallis test. Results During the observation period, 172160 patients were admitted to the hospital, of which 169 were maintenance dialysis patients. One hundred and twenty-three of them were male, with a mean age of 73.0 years. Diabetic kidney disease was the most common cause of ESKD (n=128), followed by chronic glomerulonephritis (n=21), nephrosclerosis (n=19), and autosomal polycystic kidney disease (n=1). The median time on dialysis was 5 years. Seventy-three patients were admitted for peripheral vascular disease, 24 for cardiovascular disease, 24 for fractures, 16 for gastrointestinal disease, 13 for cerebrovascular disease, and remainder for other conditions. Inpatient costs ranged from €764 to €79743, with a mean of €14884, and a median of €9002. Inpatient costs did not differ significantly by age, sex, time on dialysis, number of complications, or cause of ESKD. There were significant differences in inpatient costs according to the reason for admission. Patients hospitalized for cerebrovascular disease had significantly higher inpatient costs with a mean of €17733 and a median of €14623 (P = .049). During the study period, dialysis patients accounted for 0.098% of all inpatient admissions, and their medical costs were 3% of the hospital's total inpatient medical costs. Conclusion Considering the number of dialysis patients as a percentage of all inpatients during the study period, it was clear that dialysis patients had a high cost burden. Among dialysis patients, hospitalization for cerebrovascular disease was associated with significantly higher costs.

Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study

This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.

The impacts of diagnosis-intervention packet payment on the providers' behavior of inpatient care-evidence from a national pilot city in China.

In 2020, the Chinese government developed and implemented an innovative case-based payment method under the regional global budget called the diagnosis-intervention packet (DIP) payment to pay for inpatient care. This study aims to assess the changes to inpatient care provision in hospitals after the DIP payment reform was implemented. This study used inpatient medical costs per case, the proportion of the out-of-pocket (OOP) expenditure in inpatient medical costs, and the average length of stay (LOS) of inpatient care as outcome variables, and conducted an interrupted time series analysis to evaluate changes after the DIP payment reform. January 2021 was taken as the intervention point when a national pilot city of the DIP payment reform in the Shandong province began using the DIP payment to pay for inpatient care of secondary and tertiary hospitals. The data used in this study were obtained from the aggregated monthly claim data of inpatient care of secondary and tertiary hospitals. Compared to the pre-intervention trend, the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs both in tertiary and secondary hospitals significantly decreased after the intervention. After the intervention, the reduction in the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs in tertiary hospital were both higher than those in secondary hospital (p < 0.001). The average LOS of inpatient care in secondary hospital significantly increased after the intervention, and it immediately increase 0.44 day after intervention (p = 0.211). Moreover, the change of average LOS of inpatient care in secondary hospital after intervention was opposite to that in tertiary hospital, it had no statistical difference (p = 0.269). In the short term, the DIP payment reform could not only effectively regulate provider behavior of inpatient care in hospitals, but also improves the rational allocation of the regional healthcare resources. However, the long-term effects of the DIP payment reform need to be investigated in the future.

The associations of continuity of care with inpatient, outpatient, and total medical care costs among older adults with urinary incontinence

IntroductionUrinary incontinence is a significant health problem with considerable social and economic consequences among older adults. The objective of this study was to investigate the financial impact of continuity of care (CoC) among older urinary incontinence patients in South Korea. MethodsWe used the NHIS-Senior cohort patient data between January 1, 2010, and December 31, 2010. Patients who were diagnosed with urinary incontinence in 2010 were included. Operational definition of CoC included referrals, number of providers, and number of visits. A generalized linear model (GLM) with γ-distributed errors and the log link function was used to examine the relationship between health cost and explanatory variables. Additionally, we conducted a two-part model analysis for inpatient cost. Marginal effect was calculated.ResultsHigher CoC was associated with a decrease in total medical cost (-0.63, P < .0001) and in outpatient costs (-0.28, P < .001). Higher Charlson Comorbidity Index (CCI) score was a significant predictor for increasing total medical cost (0.59, P < .0001) and outpatient cost (0.22, P < .0001). Higher CoC predict a reduced medical cost of $360.93 for inpatient cost (P = 0.044) and $23.91 for outpatient cost (P = 0.008) per patient.ConclusionHigher CoC was associated with decrease in total medical costs among older UI patients. Policy initiatives to promote CoC of older UI patients in the community setting could lead to greater financial sustainability of public health insurance in South Korea.

Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis

ObjectiveThis study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain.MethodsAdmission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study.Results95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI.ConclusionsPatients’ condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.

Costs of traditional Chinese medicine treatment for inpatients with lung cancer in China: a national study

BackgroundTraditional Chinese Medicine (TCM) has long been a widely recognized medical approach and has been covered by China’s basic medical insurance schemes to treat lung cancer. But there was a lack of nationwide research to illustrate the impact of the use of TCM on lung cancer patients’ economic burden in mainland China. Therefore, we conduct a nationwide study to reveal whether the use of TCM could increase or decrease the medical expenditure of lung cancer inpatients in mainland China.MethodsThis is a 7-year cross-sectional study from 2010 to 2016. The data is a random sample of 5% from lung cancer claims data records of Chinese Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI). Mann-Whitney test was used to compare inpatient cost data with positive skewness. Ordinary least squares regression analysis was performed to compare the total TCM users’ hospitalization cost with TCM nonusers’, to examine whether TCM use is the key factor inducing relatively high medical expenditure.ResultA total of 47,393 lung cancer inpatients were included in this study, with 38,697 (81.7%) of them at least using one kind of TCM approach. The per inpatient medical cost of TCM users was RMB18,798 (USD2,830), which was 65.2% significantly higher than that of TCM nonusers (P < 0.001). The medication cost, conventional medication cost, and nonpharmacy cost of TCM users were all higher than TCM nonusers, illustrating the higher medical cost of TCM users was not induced by TCM only. With confounding factors fixed, there was a positive correlation between TCM cost and conventional medication cost, nonpharmacy cost (Coef. = 0.283 and 0.211, all P < 0.001), indicting synchronous increase of TCM costs and conventional medication cost for TCM users.ConclusionThe use of TCM could not offset the utilization of conventional medicine, demonstrating TCM mainly played a complementary role but not an alternative role in the inpatient treatment of lung cancer. A joint Clinical Guideline that could balance the use of TCM and Conventional medicine should be developed for the purpose of reducing economic burden for lung cancer inpatients.

The burden of hospitalisations for COVID-19 in France: a study of all cases in the national insurance claims database in 2020

ABSTRACT Background The economic consequences of the recent COVID-19 pandemic were substantial. However, direct medical costs in France have not been determined. Objective To describe patient characteristics, intensity of care, mortality, and direct medical costs in patients hospitalised for COVID-19 infections in France. Study design A retrospective study of the French national hospital claims database for 2020. Setting Hospital care. Patients or other participants All patients hospitalised for COVID-19 in 2020 were included and classified by hospitalisation duration into acute phase and prolonged COVID-19. Intervention Stratification by intensity of care (Level 1: no or low-flow oxygen support; Level 2: non-invasive ventilation; Level 3: mechanical ventilation). Main outcome measure Cost of hospital care in 2020 Euros from a payer perspective. Results 199,455 patients were hospitalised for COVID-19 in France in 2020. 17,824 patients (8.9%) received mechanical ventilation and 32,602 patients (16.3%) died. Mean per patient cost was €5,510 ± 7,142. This cost was highest in patients receiving Level 3 care, patients aged >80 years and in those with prolonged COVID. Conclusion The economic burden of hospitalisations for COVID-19 infections in France during 2020 was substantial. The study provides robust baseline data to benchmark advances in the standard of care and to nurture epidemiological models.

Estimation of Medical Costs for Ischemic Stroke Patients - From the Perspective of a Health Care Provider

The increasing prevalence of stroke has presented challenges to all countries. Since 2007, stroke has been one of the leading causes of death in Malaysia. Furthermore, the number of strokes is expected to increase steadily. Certainly, all parties are concerned, particularly considering the socioeconomic burden that must be borne. As a result, the community and health-care providers must measure the number required to cover the medical expenses associated with a stroke. The estimated medical costs are based on the medical costs of ischemic stroke patients treated at Hospital Canselor Tuanku Mukhriz, which involved a total of 2161 stroke patients between 2016 and 2020. Demographic factors such as age and gender, as well as clinical factors such as severity, length of stay (LOS), and comorbid factors, were used to determine the medical costs of ischemic stroke patients. A logarithmic transformation was carried out on the medical cost to create a more suitable medical cost estimating model, considering the skewed nature of the medical cost data of ischemic stroke patients. As a result of the multiple linear regression analysis, age, LOS, severity level, type of comorbidity such as hypertension, ischemic heart disease (IHD), atrial fibrillation (AF), smoking and alcohol habits were found to have a significant effect on these medical costs. However, a patient's medical costs are unaffected by gender or type of comorbidity, such as diabetes or hyperlipidemia. Furthermore, it was discovered that increased LOS, severity levels, or the presence of comorbidities such as IHD, AF, and smoking habits all increased patients' medical costs. Medical costs, on the other hand, were found to be lower in patients who were older, consumed alcohol, and had hypertension.

The impacts of the National Medication Price-Negotiated Policy on the financial burden of cancer patients in Shandong province, China: an interrupted time series analysis

BackgroundIn order to further regulate the price of anticancer medication and alleviate the financial burden of cancer patients, the Chinese government implemented the National Medication Price-Negotiated Policy (NMPNP) in 2017. This study aims to assess the impacts of implementation of the NMPNP on the access of anticancer medication and the financial burden for cancer patients in Shandong province, and to provide evidence to inform the design of similar policies in other developing countries.MethodsA quasi-experiment design of an interrupt time series analysis was conducted. The month of September 2017 was taken as the intervention point when the Shandong Provincial Reimbursement Drug Lists was updated based on the result of the NMPNP in 2017. The data used were the aggregated monthly claim data of cancer patients from 2016 to 2021, which were obtained from four cities in Shandong province. The outpatient and inpatient care visits per capita, proportion of OOP expenditure and medication costs in outpatient and inpatient medical costs were used as outcome variables. A segmented regression model was used to analyze the change of the access of anticancer medication and the financial burden for cancer patients.ResultsThe outpatient care visits per capita significantly decreased after the intervention. Compared to preintervention trend, the proportion of OOP expenditure in outpatient medical costs decreased by average 0.25 percentage point per month (p < 0.0001) after the intervention, however the proportion of OOP expenditure in inpatient medical costs increased by 0.02 percentage point per month (p = 0.76). Since the intervention, the proportion of medication costs in outpatient medical costs averagely rose by 0.28 percentage point (p < 0.0001), and its implementation caused the proportion of medication costs in inpatient medical costs averagely decreased 0.2 percentage point (p < 0.0001).ConclusionsThe NMPNP improved the access of anticancer medication, and relieved the financial burden of outpatient care. However, it did not effectively alleviate the financial burden of inpatient care. Additionally, the NMPNP impacted the behavior of the healthcare providers. The policymakers should closely monitor the change of providers behaviors, and dynamically adjust financial incentives policies of healthcare providers during the implementation of similar medication price negotiated policies.

Comparison between transoral radiofrequency coblation surgery and open partial laryngectomy for the treatment of supraglottic laryngeal carcinoma

Objective: To explore the feasibility and efficacy of radiofrequency coblation assisted transoral surgery for the treatment of supraglottic laryngeal carcinoma by comparing with concurrent patients treated with conventional transcervical approach. To clarify the advantages of different surgical methods and to summarize the experience of supraglottic carcinoma radiofrequency ablation. Methods: Forty-six patients with supraglottic laryngeal carcinoma treated in department of otorhinolaryngology head and neck surgery, Peking University First Hospital from March 2014 to January 2021 were analyzed retrospectively. Among them(43 males, 3 females, aged from 45 to 79 years old), 23 patients were treated with radiofrequency coblation and 23 patients with partial laryngectomy with conventional transcervical approach. The operation time, intra-operative blood loss volume, recovery time, inpatient total medical cost and follow-up information of the two groups were analyzed. SPSS 26.0 software was used for statistical analysis. Results: There were no significant differences in age, gender, TNM staging,tumor staging and postoperative radiotherapy between the two groups (all P>0.05).The operation time, intra-operative blood loss volume, recovery time, inpatient total medical cost of the RFC-TOS group were110.0(60.0,150.0)min,5.0(5.0,30.0)ml,3.0(2.0,5.0)days,6.0(4.0,14.0)days and 26 100.7(16 145.5,47 044.4)yuan. The data of conventional transcervical approach group were 205.0(156.5,272.3)min, 150.0(50,200) ml, 18.0(16.3,22.8)days and 56520.1(440 992.5,67 109.9)yuan, (Z=-4.03, -4.94, -4.97, -4.98 and -4.13;all P<0.001).The 5-year local control rate, disease-specific survival rate and overall survival rate of the two groups were 86.96%,95.65%,91.30% and 86.96%,91.30%,73.90% renspectively, which had no significant difference between the two groups(all P>0.05). Conclusions: Compared with conventional transcervical surgeries, RFC-TOS could be a reliable new surgical option for organ-function preservation strategy in the treatment of supraglottic laryngeal carcinoma.The RFC is a suitable new technique and deserving more multi-center clinical trials for its clinical promotion.

SA7 Reduced Health Care Resource Utilisation and Costs Following a Switch From Multiple-Inhaler to Once-Daily Single-Inhaler Triple Therapy in COPD Patients in a Real-World Primary Care Setting in England

To investigate all-cause and chronic obstructive pulmonary disease (COPD)-related health care resource utilisation (HCRU) and direct medical costs in patients with COPD before and after switching from multiple-inhaler triple therapy (MITT) to once-daily single-inhaler triple therapy (SITT) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).

Patient-related healthcare costs for diarrhoea, Guillain Barré syndrome and invasive non-typhoidal salmonellosis in Gondar, Ethiopia, 2020

BackgroundGlobally, foodborne diseases result in a significant disease burden with low- and middle-income countries disproportionately affected. Estimates of healthcare costs related to foodborne disease can aid decision makers to take action to mitigate risks and prevent illness. However, only limited data on the African continent are available, especially related to more severe sequelae. We provide estimates of direct and indirect (non)-medical costs of patients with diarrhoea, Guillain-Barré syndrome (GBS), and invasive non-typhoidal salmonellosis (iNTS) in three healthcare facilities in Gondar, Ethiopia.MethodsWe used healthcare data from patient records, interviews with family caregivers and 2020 healthcare resource unit costs. Descriptive statistical analysis was performed. For diarrhoea, differences in mean and median transformed costs between healthcare facilities and etiologies (Campylobacter spp., enterotoxigenic Escherichia coli, non-typhoidal Salmonella enterica) were analysed with ANOVA and chi squared tests. Contribution of healthcare facility, dehydration severity, sex, age and living area to transformed costs was identified with linear regression. Results are in 2020 USD per patient. To extrapolate to national level, 2017 national incidence estimates were used.ResultsMean direct medical costs were 8.96 USD for diarrhoea (health centre 6.50 USD, specialised hospital 9.53 USD, private clinic 10.56 USD), 267.70 USD for GBS, and 47.79 USD for iNTS. Differences in costs between diarrhoea patients were mainly associated with healthcare facility. Most costs did not differ between etiologies. Total costs of a diarrhoea patient in the specialised hospital were 67 USD, or 8% of gross national income per capita. For direct medical plus transport costs of a GBS and iNTS patient in the specialised hospital, this was 33% and 8%, respectively. Of the 83.9 million USD estimated national non-typhoidal Salmonella enterica related cost, 12.2% was due to iNTS, and of 187.8 million USD related to Campylobacter spp., 0.2% was due to GBS.ConclusionDirect medical costs per patient due to GBS and iNTS were 30 respectively five times those due to diarrhoea. Costs of a patient with diarrhoea, GBS or iNTS can be a substantial part of a household’s income. More severe sequalae can add substantially to cost-of-illness of foodborne hazards causing diarrheal disease.

Economic burden of complicated ureteral stent removal in patients with kidney stone disease in the USA.

Aim: To examine the medical costs of simple versus complicated ureteral stent removal. Materials &methods: We included adults with kidney stones undergoing simple or complicated cystoscopy-based stent removal (CBSR) postureteroscopy from the2014 to2018 Merative™ MarketScan® Commercial Database. The medical costs of patients with complicated and simple CBSR were compared. Results: Among 16,682 patients, 2.8% had complicated CBSR. Medical costs for patients with complicated CBSR were higher than for simple CBSR ($2182 [USD] vs $1162; p<0.0001). Increased stenting time, increased age, southern US geographyand encrusted stent diagnoses were significantly associated with complicated CBSR. Conclusion: Complicated ureteral stent removal doubled the medical costs associated with CBSR. Ureteral stents with anti-encrustation qualities may reduce the need for complicated CBSR and associated costs.

Delay in psychiatric hospitalization from the diagnosis of first-episode schizophrenia and its association with clinical outcomes and direct medical costs: a nationwide, health insurance data-based study

BackgroundEarly intervention is essential for improving the prognosis in patients with first-episode schizophrenia (FES). The Mental Health Act limits involuntary hospitalization in South Korea to cases where an individual exhibits both a mental disorder and a potential for harming themselves or others, which could result in a delay in the required treatment in FES. We investigated the effect of delay in the first psychiatric hospitalization on clinical outcomes in FES.MethodsThe South Korean Health Insurance Review Agency database (2012–2019) was used. We identified 15,994 patients with FES who had a record of at least one psychiatric hospitalization within 1 year from their diagnosis. A multivariate linear regression model and a generalized linear model with a gamma distribution and log link were used to examine associations between the duration from the diagnosis to the first psychiatric admission and clinical outcomes as well as direct medical costs after 2 and 5 years.ResultsWithin both the 2-year and the 5-year period, longer durations from the diagnosis to the first psychiatric admission were associated with an increase in the number of psychiatric hospitalizations (2-y: B = 0.003, p = 0.003, 5-y: B = 0.007, p = 0.001) and an increase in direct medical costs (total: 2-y: B = 0.005, p < 0.001, 5-y: B = 0.004, p = 0.005; inpatient care: 2-y: B = 0.005, p < 0.001, 5-y: B = 0.004, p = 0.017).ConclusionsEarlier psychiatric admission from the diagnosis is associated with a decrease in the number of psychiatric admissions as well as in direct medical costs in patients with FES.

IMPACT OF INITIATING SELEXIPAG WITHIN 12 MONTHS OF PULMONARY ARTERIAL HYPERTENSION DIAGNOSIS ON HOSPITALIZATION AND HEALTH CARE COSTS

IMPACT OF INITIATING SELEXIPAG WITHIN 12 MONTHS OF PULMONARY ARTERIAL HYPERTENSION DIAGNOSIS ON HOSPITALIZATION AND HEALTH CARE COSTS

Direct Medical Costs and Healthcare Resource Utilization of Treating Patients With Two Clinical Subtypes of Axial Spondyloarthritis in Colombia

ObjectivesThis study aimed to calculate the healthcare resource utilization and direct medical costs in patients with 2 subtypes of axial spondyloarthritis (axSpA) in a rheumatic care center in Colombia. MethodsThis is a retrospective cost-of-illness study. Patients with at least 1 medical consultation associated with an axSpA diagnosis between October 2018 and October 2019 were identified. Patients were classified as having radiographic (r-axSpA) or nonradiographic axSpA (nr-axSpA). Direct medical costs were calculated in Colombian pesos and expressed in American dollars using an exchange rate of 3263 Colombian pesos = 1 US dollar ($). Predictors of total direct costs were identified using a generalized linear model with gamma distribution and log-link. ResultsA total of 162 patients with a mean age of 49.6 years (± 13.7) were included in the study. Among these, 147 (90.7%) were considered as having r-axSpA and 15 (9.3%) nr-axSpA, with mean costs of $6600 (± 6203) and $843 (± 1135), respectively (P < .001). The total direct mean cost was calculated at $6067 (± 6144) per patient. Medication costs were the main driver of total costs (97.6%, $5921), with biologic disease-modifying antirheumatic drugs accounting for nearly 92.0% ($5582) of these costs. Rheumatologist (100%) and physiatrist (64.2%) visits were the most frequently used medical service. ConclusionsThe economic burden associated with axSpA in the Colombian setting is substantial. There is a significant difference in direct medical costs between the r-axSpA and the nr-axSpA. Health policies aimed at the comprehensive management of nr-axSpA would have an important role in the reduction of the associated direct medical costs.

The Influence of the Rural Transitions Nurse Program for Veterans on Healthcare Utilization Costs.

The Veterans Affairs (VA) Healthcare System Rural Transitions Nurse Program (TNP) addresses barriers veterans face when transitioning from urban tertiary VA hospitals to home. Previous clinical evaluations of TNP have shown that enrolled veterans were more likely to follow up with their primary care provider within 14 days of discharge and experience a significant reduction in mortality within 30 days compared to propensity-score matched controls. Examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for TNP enrollees compared to controls. Quantitative analyses modeling the changes in cost via multivariable linear mixed-effects models to determine the association between TNP enrollment and changes in these costs. Veterans meeting TNP eligibility criteria who were discharged home following an inpatient hospitalization at one of the 11 implementation sites from April 2017 to September 2019. The four-step TNP transitional care intervention. Changes in 30-day total, inpatient, and outpatient healthcare utilization costs were calculated for TNP enrollees and controls. Among 3001 TNP enrollees and 6002 controls, no statistically significant difference in the change in total costs (p = 0.65, 95% CI: (- $675, $350)) was identified. However, on average, the increase in inpatient costs from pre- to post-hospitalization was approximately $549 less for TNP enrollees (p = 0.02, 95% CI: (- $856, - $246)). The average increase in outpatient costs from pre- to post-hospitalization was approximately $421 more for TNP enrollees compared to controls (p = 0.003, 95% CI: ($109, $671)). Although we found no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs. This suggests a shifting of costs from the inpatient to outpatient setting.

National Trends in Medical Costs and Prognosis of Acute Ischemic Stroke Patients in Endovascular Thrombectomy Era: Analysis Using Medical Claim Data in Korea.

The purpose of this study was to evaluate trends in medical costs and prognosis in acute ischemic stroke (AIS) patients in Korea from 2008 to 2017 using medical claims data. All data for the past decade was collected from a big data hub provided by the Health Insurance Review & Assessment Service. Using several Korean Standard Classification of Disease codes, we estimated the number of patients, the costs of medical insurance, and prognosis according to the treatment with or without endovascular thrombectomy (EVT) among in-patients with AIS. Since 2014, when EVT was covered by insurance, the number of patients who underwent EVT for AIS has increased significantly. Also, in the past decade, the medical costs following inpatient care for AIS with EVT have increased gradually, and the overall medical costs for the first year post-stroke have also increased. The prognosis of AIS patients with EVT was different according to the time of treatment. Annual trends for both mortality and cerebral hemorrhage after treatment of AIS with EVT have gradually decreased. In this study, we found that both inpatient medical costs and 1-year cumulative medical costs have gradually increased, and the prognosis has gradually improved in patients receiving EVT treatment among AIS patients.

Factors Related to the Increase in Hospitalization Costs of the Elderly With Circulatory System Diseases in Ahvaz, Iran During 2015-2016 Using the Generalized Gamma Marginalized Two-part Model

Objectives One of the challenges facing societies today is the increased medical expenses of the elderly. Therefore, identifying the factors associated with this increase can help health policymakers control the costs imposed on the elderly and their families. This study aims to identify the factors related to the increase in hospitalization costs of the elderly with circulatory system diseases using the generalized gamma marginalized two-part model. Methods &amp; Materials In this retrospective cohort study, 335 samples were selected by a simple random sampling method from among the older patients of Imam Khomeini and Golestan hospitals in Ahvaz, Iran during 2015-2016 having circulatory system diseases and age ≥60 years. The relationship of age, gender, hospitalization status in intensive care unit (ICU), marital status, admission season, and number of hospitalization days with the increase in treatment costs of the elderly was examined using the generalized gamma marginalized two-part model in SAS 9.4 software. The response variable was the patients’ treatment costs. The significance level was set at 0.05. Results The mean age of participants was 70.718.27 years, where 54% were female and 46% were male. The average medical costs in patients admitted to ICU was 3.70 times higher than that in patients who were not admitted to this unit. The odds ratio showed that, for each day of increase in hospital stay, the hospitalization costs of the patients increased by 1.11. The hospitalization costs for older men were 1.67 times higher than in older women. In single patients, it was 2 times higher than in married patients. Moreover, with each year of increase in age (after age 60), the hospitalization costs increased by 0.96. Using the marginalized two-part model, it was found that the variables of age, number of hospitalization days, marital status, gender, and admission to ICU had a significant relationship with the increase in the hospitalization costs of the elderly (P&lt;0.05). Conclusion The burden of hospitalization costs on younger elderly with circulatory system diseases is higher. Older men incur more hospital costs than older women, and single elderly people incur more hospital costs than married ones. The increase in the number of hospitalization days is another factor that can increase the hospitalization costs of the older patients, especially in those admitted to ICU.

The Additional Medical Expenditure Caused by Depressive Symptoms among Middle-Aged and Elderly Patients with Chronic Lung Diseases in China.

Depression is one of the most common comorbidities in patients with chronic lung diseases (CLDs). Depressive symptoms have an obvious influence on the health function, treatment, and management of CLD patients. In order to investigate the additional medical expenditure caused by depressive symptoms among middle-aged and elderly patients with CLDs in China, and to estimate urban–rural differences in additional medical expenditure, our study used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) investigation. A total of 1834 middle-aged and elderly CLD patients were included in this study. A generalized linear regression model was used to analyze the additional medical expenditure on depressive symptoms in CLD patients. The results show that depressive symptoms were associated with an increase in medical costs in patients with CLDs. Nevertheless, the incremental medical costs differed between urban and rural patients. In urban and rural patients with more severe comorbid CLD and depressive symptoms (co-MCDs), the total additional medical costs reached 4704.00 Chinese Yuan (CNY) (USD 711.60) and CNY 2140.20 (USD 323.80), respectively. Likewise, for patients with lower severity co-MCDs, the total additional medical costs of urban patients were higher than those of rural patients (CNY 4908.10 vs. CNY 1169.90) (USD 742.50 vs. USD 176.90). Depressive symptoms were associated with increased medical utilization and expenditure among CLD patients, which varies between urban and rural areas. This study highlights the importance of mental health care for patients with CLDs.