NHS Hospital Episode Statistics Research Articles

RWD175 Insights From the NHS Hospital Episode Statistics on Primary Procedures During Hospital Admission in Patients With Chronic Limb Ischemia in Superficial Femoral and Popliteal Arteries

RWD175 Insights From the NHS Hospital Episode Statistics on Primary Procedures During Hospital Admission in Patients With Chronic Limb Ischemia in Superficial Femoral and Popliteal Arteries

Health care utilisation in patients with mild pulmonary hypertension - EVIDENCE-PAH UK study

Abstract Background ESC/ERS 2022 guidelines1, redefined precapillary pulmonary hypertension (PH) as patients with a mPAP>20mmHg,PVR>2WU and PAWP<15mmHg1.We and others identified patients with mildly elevated pulmonary artery(PA) pressures demonstrates a higher mortality2-4. It is important to understand healthcare resource utilisation(HRCU) in this newly defined group who now meet the thresholds for diagnosis, however, treatment options are limited. Purpose The EVIDENCE-PAH aims to describe mortality and hospitalisation outcomes, baseline demographics in mild elevations in PA pressure in a national cohort. We report preliminary analysis of HRCU from data obtained from NHS Hospital Episode Statistics(HES); inpatient admissions, outpatient(OP) and emergency attendances(AE). Method Retrospective analysis of all patients with a mPAP<25mmHg and a sample of patients with a mPAP≥25mmHg at index-right heart catheterisation(RHC), across all UK PH tertiary centres between 2009-2017 with hospitalisation data captured 24-months pre and post index-RHC. For analysis patients were categorised into 3 groups; normal haemodynamics(mPAP<21mmHg & PVR≤2WU), mild elevation in haemodynamics(mPAP<21mmHg & PVR>2WU, mPAP21-24mmHg with all PVR groups, mPAP>25mmHg & PVR≤3WU) and abnormal haemodynamics(mPAP>25mmHg & PVR>3WU). Results A total of 2413(82.3%) patients had complete records 24-months pre and post index-RHC; 561(23.2%), 1228(50.9%) and 624(25.9%) in the normal haemodynamic, mildly elevated haemodynamic and abnormal haemodynamic groups respectively. Figure 1, demonstrates HRCU; Unscheduled admissions are significantly higher in the abnormal haemodynamic group 24-months pre index-RHC compared to the normal/mild elevations in haemodynamic groups (p-value<0.05). There was reduction in unscheduled encounters 24-months post index-RHC in the normal/abnormal haemodynamic group. No significant difference identified in AE attendance and OP 24-months post across all haemodynamic groups. Total HRCU demonstrates a lower attendance 24-months post RHC in normal versus abnormal haemodynamic group (p-value<0.05). Multivariate analysis demonstrates unscheduled admissions 24-months pre/post index RHC, as an independent predictor of survival, adjusted for age, sex and haemodynamics (Figure 2;p-value<0.05). Conclusion Unscheduled admissions may act as a discriminator identifying advanced PH (abnormal haemodynamics), but not normal versus mild elevations in haemodynamics. Meanwhile AE and OP attendances fails to discriminate between normal and mild elevation in haemodynamics. Unscheduled admissions 24-months pre/post index RHC is an independent predictor of survival which may lend as a useful surrogate marker for mortality in the PH population as a whole. Although total HRCU appears high across haemodynamics groups referred to PH centre, in the 24-months post RHC HRCU increases in the mild/abnormal haemodynamic groups, this may represent ongoing unmet need in this group.

Screening for psychological distress in childhood and mental health-related hospital attendance among young adults

ObjectivesThe prevalence of mental disorders is high and increasing among children and young people. Investigating the relationship between self-reported poor mental health and mental health service utilisation can provide evidence on the benefits of universal screening, but longitudinal data is rare. ApproachData from a nationally representative English cohort (Next Steps) were linked to NHS Hospital Episode Statistics. GHQ-12 assessed psychological distress in Next Steps at age 15; participants were followed until their first mental health-related hospital presentations or were censored at the end of the study (age 27). Cox proportionate hazard models with survey weights estimated associations. ResultsOut of 4058 young people included in the analyses, 19% reported high levels of distress at age 15. During the 12-year follow-up, 5.3%, 2.9% and 2.7% of the participants had at least one mental disorder, drug/alcohol misuse and self-harm presentation, respectively, and 4.2% had a mental health treatment. Higher GHQ-12 scores were associated with mental disorder presentations (HR=1.10, 95% CI:1.04-1.16), and mental health treatments (HR=1.14, 95% CI:1.08-1.20). Associations were weaker for young people living in deprived areas, or if their main parent had lower education. ConclusionsAdolescent psychological distress predicts subsequent hospital attendance in young adulthood, but there are treatment gaps in service utilisation among more disadvantaged individuals. Detecting youth with mental health difficulties through universal screening, may facilitate early intervention, improve life-course outcomes, and reduce secondary healthcare use. ImplicationsLinked cohort and administrative data can improve our understanding on long-term healthcare utilisation and treatment needs.

Reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis: population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England

ObjectivesTo answer a national research priority by comparing the risk-benefit and costs associated with reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) in patients having elective primary...

Healthcare systems data in the context of clinical trials – A comparison of cardiovascular data from a clinical trial dataset with routinely collected data

BackgroundRoutinely-collected healthcare systems data (HSD) are proposed to improve the efficiency of clinical trials. A comparison was undertaken between cardiovascular (CVS) data from a clinical trial database with two HSD resources. MethodsProtocol-defined and clinically reviewed CVS events (heart failure (HF), acute coronary syndrome (ACS), thromboembolic stroke, venous and arterial thromboembolism) were identified within the trial data. Data (using pre-specified codes) was obtained from NHS Hospital Episode Statistics (HES) and National Institute for Cardiovascular Outcomes Research (NICOR) HF and myocardial ischaemia audits for trial participants recruited in England between 2010 and 2018 who had provided consent. The primary comparison was trial data versus HES inpatient (APC) main diagnosis (Box-1). Correlations are presented with descriptive statistics and Venn diagrams. Reasons for non-correlation were explored. ResultsFrom 1200 eligible participants, 71 protocol-defined clinically reviewed CVS events were recorded in the trial database. 45 resulted in a hospital admission and therefore could have been recorded by either HES APC/ NICOR. Of these, 27/45 (60%) were recorded by HES inpatient (Box-1) with an additional 30 potential events also identified. HF and ACS were potentially recorded in all 3 datasets; trial data recorded 18, HES APC 29 and NICOR 24 events respectively. 12/18 (67%) of the HF/ACS events in the trial dataset were recorded by NICOR. ConclusionConcordance between datasets was lower than anticipated and the HSD used could not straightforwardly replace current trial practices, nor directly identify protocol-defined CVS events. Further work is required to improve the quality of HSD and consider event definitions when designing clinical trials incorporating HSD.

Automated deep learning quantification of epicardial adiposity on cardiac CT predicts atrial fibrillation risk immediately following cardiac surgery and long-term

Abstract Introduction Epicardial adipose tissue (EAT) is a visceral fat deposit within the pericardial sac which surrounds the heart myocardium and coronary arteries. The automated quantification of EAT volume is possible from routine CCTA scans via a deep-learning approach. The use of automated EAT quantification for the assessment of atrial fibrillation (AF) risk in the post-operative period, and longer-term, has not been previously investigated. Purpose To apply a deep-learning approach for automated segmentation of EAT from routine CCTA scans to assess the immediate post-operative and long-term risk of AF conveyed by EAT. Methods A deep-learning automated EAT segmentation tool using a 3D Residual-U-Net neural network architecture for 3D volumetric segmentation of CCTA data was created and trained on over 2800 consecutive CCTA performed as part of clinical care in patients with stable chest pain from 2015 onwards within the European arm of the Oxford Risk Factors And Non Invasive Imaging (ORFAN) Study. External validation in 817patients demonstrated excellent correlation between machine and human expert (CCC = 0.972). The prognostic value of deep-learning derived EAT volume was assessed in the AdipoRedOx Study (n=253; UK patients undergoing cardiac surgery) against both immediate in-hospital outcomes and longer-term outcomes from UK-wide NHS data, with adjustment for AF risk factors. Results There were 97 cases of new-onset AF in the immediate post-operative period (38.3%). EAT volume was found to be an independent predictor of post-operative AF regardless of body mass index. Utilising the median EAT volume as the cut point, the adjusted hazard ratio (HR [95% CI]) for risk of new-onset post-operative AF in-hospital was 1.56 [1.09–3.85], p<0.01 (Figure 1A). In receiver-operator characteristic analysis EAT volume added significant incremental prognostic power for the discrimination of in-hospital post-operative AF over a traditional risk factor model ΔAUC=0.101, p<0.01 (Figure 1B). Over a median follow-up period of 89 months there were 48 unique cases (19%) of confirmed AF found in nation-wide NHS hospital episode statistics data for the AdipoRedOx cohort. EAT volume was found to be a significant independent predictor of long-term AF. Utilising the median EAT volume as the cut point, the adjusted HR for risk of new-onset long-term AF following cardiac surgery was 1.25 [1.08–3.17], p<0.01 (Figure 1C). Conclusions Automatically segmented EAT volume measured using a deep learning network predicts risk of both short-term new onset AF following cardiac surgery, and long-term risk of AF in the 7 years following the surgery independently of BMI and AF risk factors. This suggests that EAT is a potent mediator of AF risk in the post cardiac surgery setting. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation - TG/19/2/34831EU Commission - 965286

What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020-2029.

There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability. Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau-age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall-age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY). The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs. After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links between COVID-19 and cardiovascular health, effective cardiovascular prevention policies need to be revitalised urgently.

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

ObjectiveTo define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsAll patients who underwent first SAVR or TAVI...

Open urethroplasty versus endoscopic urethrotomy for recurrent urethral stricture in men: the OPEN RCT.

Men who suffer recurrence of bulbar urethral stricture have to decide between endoscopic urethrotomy and open urethroplasty to manage their urinary symptoms. Evidence of relative clinical effectiveness and cost-effectiveness is lacking. To assess benefit, harms and cost-effectiveness of open urethroplasty compared with endoscopic urethrotomy as treatment for recurrent urethral stricture in men. Parallel-group, open-label, patient-randomised trial of allocated intervention with 6-monthly follow-ups over 24 months. Target sample size was 210 participants providing outcome data. Participants, clinicians and local research staff could not be blinded to allocation. Central trial staff were blinded when needed. UK NHS with recruitment from 38 hospital sites. A total of 222 men requiring operative treatment for recurrence of bulbar urethral stricture who had received at least one previous intervention for stricture. A centralised randomisation system using random blocks allocated participants 1 : 1 to open urethroplasty (experimental group) or endoscopic urethrotomy (control group). The primary clinical outcome was control of urinary symptoms. Cost-effectiveness was assessed by cost per quality-adjusted life-year (QALY) gained over 24 months. The main secondary outcome was the need for reintervention for stricture recurrence. The mean difference in the area under the curve of repeated measurement of voiding symptoms scored from 0 (no symptoms) to 24 (severe symptoms) between the two groups was -0.36 [95% confidence interval (CI) -1.78 to 1.02; p = 0.6]. Mean voiding symptom scores improved between baseline and 24 months after randomisation from 13.4 [standard deviation (SD) 4.5] to 6 (SD 5.5) for urethroplasty group and from 13.2 (SD 4.7) to 6.4 (SD 5.3) for urethrotomy. Reintervention was less frequent and occurred earlier in the urethroplasty group (hazard ratio 0.52, 95% CI 0.31 to 0.89; p = 0.02). There were two postoperative complications requiring reinterventions in the group that received urethroplasty and five, including one death from pulmonary embolism, in the group that received urethrotomy. Over 24 months, urethroplasty cost on average more than urethrotomy (cost difference £2148, 95% CI £689 to £3606) and resulted in a similar number of QALYs (QALY difference -0.01, 95% CI -0.17 to 0.14). Therefore, based on current evidence, urethrotomy is considered to be cost-effective. We were able to include only 69 (63%) of the 109 men allocated to urethroplasty and 90 (80%) of the 113 men allocated to urethrotomy in the primary complete-case intention-to-treat analysis. The similar magnitude of symptom improvement seen for the two procedures over 24 months of follow-up shows that both provide effective symptom control. The lower likelihood of further intervention favours urethroplasty, but this had a higher cost over the 24 months of follow-up and was unlikely to be considered cost-effective. Formulate methods to incorporate short-term disutility data into cost-effectiveness analysis. Survey pathways of care for men with urethral stricture, including the use of enhanced recovery after urethroplasty. Establish a pragmatic follow-up schedule to allow national audit of outcomes following urethral surgery with linkage to NHS Hospital Episode Statistics. Current Controlled Trials ISRCTN98009168. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 61. See the NIHR Journals Library website for further project information.

"Bow-tie" optimal pathway discovery analysis of sepsis hospital admissions using the Hospital Episode Statistics database in England.

ObjectiveThe “Bow-tie” optimal pathway discovery analysis uses large clinical event datasets to map clinical pathways and to visualize risks (improvement opportunities) before, and outcomes after, a specific clinical event. This proof-of-concept study assesses the use of NHS Hospital Episode Statistics (HES) in England as a potential clinical event dataset for this pathway discovery analysis approach.Materials and MethodsA metaheuristic optimization algorithm was used to perform the “bow-tie” analysis on HES event log data for sepsis (ICD-10 A40/A41) in 2016. Analysis of hospital episodes across inpatient and outpatient departments was performed for the period 730 days before and 365 days after the index sepsis hospitalization event.ResultsHES data captured a sepsis event for 76 523 individuals (>13 years), relating to 580 000 coded events (across 220 sepsis and non-sepsis event classes). The “bow-tie” analysis identified several diagnoses that most frequently preceded hospitalization for sepsis, in line with the expectation that sepsis most frequently occurs in vulnerable populations. A diagnosis of pneumonia (5 290 patients) and urinary tract infections (UTIs; 2 057 patients) most often preceded the sepsis event, with recurrent UTIs acting as a potential indicative risk factor for sepsis.DiscussionThis proof-of-concept study demonstrates that a “bow-tie” pathway discovery analysis of the HES database can be undertaken and provides clinical insights that, with further study, could help improve the identification and management of sepsis. The algorithm can now be more widely applied to HES data to undertake targeted clinical pathway analysis across multiple healthcare conditions.

The effect of a hospital liaison psychiatry service on inpatient lengths of stay: interrupted time series analysis using routinely collected NHS hospital episode statistics

BackgroundThe purpose of the study was to determine whether establishment of a specific liaison psychiatry service designed to offer a rapid response with facilitated hospital discharge led to reduced acute hospital length of inpatient stay.MethodsWe used interrupted time series based upon routine NHS data from secondary care service in two acute general hospitals, for all adult (16+ years) inpatient admissions (114,029 inpatient spells representing 70,575 individual patients) over 3 years.ResultsLength of stay reduced over time in both hospitals. Against a background of falling length of stay across the study period, there was no discernible effect of the rapid access/early discharge liaison service on length of stay, either as a step change or linear decline. This finding held for all patients and for those over 65 years and those discharged with a mental health diagnosis.ConclusionsUsing routine NHS data for a whole hospital it was not possible to replicate a previous report that a rapid access liaison psychiatry service for inpatients produces substantial reductions in length of stay, and commissioners of services should be cautious of claims to the contrary. Further research to determine if there is an effect for sub-groups will require major improvements in the way co-morbid mental disorders are coded in NHS practice.

PSU20 APPLY PRINCIPLES AND GOOD PRACTICE OF BUDGET IMPACT ANALYSIS IN MODEL FRAMEWORK DEVELOPMENT FOR SURGICAL DEVICE

To develop a country-level budget impact model/BIM for surgical approach under a single payer perspective and evaluate the BIM frame work according to the guidance from ISPOR Budget Impact Analysis/BIA Good Practice II Task Force and evaluate A hybrid modeling approach using a decision tree for perioperative care and a Markov model for long term treatment was applied for this BIM for patients with endometrial cancer who underwent open, traditional laparoscopic and robotic-assisted hysterectomy. The time horizon was set to 1/5/7/10 year and the study perspective was UK National Health Service/NHS. Country-level targeted population was obtained from literature using NHS Hospital Episode Statistics (HES). Model input parameters was from literature review. Cost were based on NHS National Health Service reference cost 2017-2018. Surgical equipment costs and surgical approach market share are based on publicly available information. Deterministic sensitivity analyses were performed to explore parametric uncertainties. Further, the aspects, elements and report format of the BIM framework was evaluated against ISPOR BIA principle of good practice. The compliant and uncompliant aspects were reported. Model outputs and reports will be then generated from the framework. For patients underwent hysterectomy for endometrial cancer, surgical equipment, conversion-to-open, perioperative complications, length of stay, and operation room were considered in the cost of perioperative care. Recurrence monitoring, radiation and chemo therapy, and the treatments for adverse events were included in the long-term cost. The BIM framework for hysterectomy is complaint with ISPOR BIA Good Practice II on 9 out of 9 aspects; the data sources for all 5 elements were clearly stated. The report of BIA is under development. Our study demonstrated that it is feasible to develop an ISPOR Good Practice Task Force complaint BIM for surgical approaches. A guideline complaint framework provided solid foundations for further analyses and reporting.

3326Infective endocarditis after transcatheter aortic valve implantation: findings from a UK nationwide linkage study

Abstract Introduction Infective endocarditis (IE) is a potentially fatal complication of prosthetic valve replacement and increasing use of transcatheter aortic valve implantation (TAVI) has resulted in a new elderly and frail population at increased risk of IE. The incidence of IE after TAVI and factors that influence the risk and subsequent outcome are relatively unknown. Purpose To describe the incidence, predictors, echocardiographic findings, microbiology and clinical outcomes of IE following TAVI in the United Kingdom (UK). Methods Patients who underwent TAVI between Jan 1 2007 and Dec 31 2016 were identified from the UK TAVI database held by the National Institute for Cardiovascular Outcomes Research. For this cohort, all hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics Admitted Patient Care database, or by contact with regional TAVI centres. Additional information concerning clinical presentation, imaging findings, microbiology, management and patient outcome were obtained where possible from the treating physician. Results A total of 16,014 patients underwent TAVI, of whom 157 developed IE over a median follow-up of 23.8 (IQR 7.8–52.4) months - an overall incidence of 0.98% (0.53% at one year post-TAVI). The mean age of patients with IE was 79.2±7.8 years, and 69% were male. The median time to IE following TAVI was 10.0 (IQR 4.0–22.3) months. On multivariate analysis, IE was significantly more common in men (HR 2.05, 95% CI 1.35–3.11, p=0.001) and in patients receiving mechanically-expandable (HR 2.15, 95% CI 1.16–4.01, p=0.015) or balloon-expandable valves (HR 1.60, 95% CI 1.01–2.52, p=0.045) compared to self-expanding valves. IE was also more common in those with an aortic valve peak gradient following TAVI deployment greater than median (HR 1.81, 95% CI 1.23–2.67, p=0.003). The most common presenting symptom was fever (present in 67.1%). The most frequent causal organisms were enterococci (25.9%), followed by oral streptococci (16.4%) and Staphylococcus aureus (11.8%). Transoesophageal echocardiography demonstrated vegetations in 72.5% of patients, most commonly on the TAVI valve leaflets (58.8%). Only 8.24% of patients underwent surgical valve intervention. Survival rates at hospital discharge and one year follow up were 61.4% and 54.4%, respectively. Specific factors associated with one-year mortality were cardiogenic shock (HR 4.6, 95% CI 2.1–10.3, p=0.0002), septic shock (HR 3.4, 95% CI 1.4–8.3, p=0.006) and stroke (HR 4.9, 95% CI 1.46–16.7, p=0.01). Conclusions The incidence of IE one year after TAVI was 0.53% and greater risk was associated with male sex, mechanically-expandable and balloon-expandable valves, and elevated post-deployment valve gradient. Enterococci were the most common causative organism. Overall survival at one year was 54.4%, with adverse outcome predicted by cardiogenic shock, septic shock or stroke.

Socio-demographic patterns in hospital admissions and accident and emergency attendances among young people using linkage to NHS Hospital Episode Statistics: results from the Avon Longitudinal Study of Parents and Children

BackgroundIn England emergency hospital admissions among children are increasing and the under 25s are the most frequent attenders of A&E departments. Children of lower socio-economic status (SES) have poorer health outcomes and higher hospital admission rates. NHS Hospital Episode Statistics (HES) are increasingly being used for research but lack detailed data on individual characteristics such as SES. We report the results of an Avon Longitudinal Study of Parents and Children (ALSPAC) study that linked the data of 3,189 consenting participants to HES. We describe rates of hospital admission, emergency readmissions, and A&E attendances and examine socio-demographic correlates of these.MethodsSubjects were singletons and twins enrolled in ALSPAC who had provided consent for linkage to their health records by the study cut-off date (31.02.12). Linkage was carried out by the Health and Social Care Information Centre (now NHS Digital). We examined rates of admissions between birth and age 20 and A&E attendances between 14 and 20 years. Socio-demographic information collected in ALSPAC questionnaires during pregnancy were used to examine factors associated with admissions, emergency readmissions (an emergency admission within 30 days of discharge) and A&E attendances.ResultsExcluding birth records, we found at least one admission for 1,792/3,189 (56.2%) participants and 4,305 admissions in total. Admission rates were highest in the first year of life. Among males, admissions declined until about age 5 and then remained relatively stable; conversely, among females, they increased sharply from the age of 15. ICD 10 chapters for diseases of the digestive system and injury and poisoning accounted for the largest proportions of admissions (15.8 and 14.5%, respectively). Tooth decay was the highest single cause of admission for those aged 5–9 years. Overall, 1,518/3,189 (47.6%) of participants attended A&E at least once, with a total of 3,613 attendances between age 14 and 20 years. Individuals from more deprived backgrounds had higher rates of admissions, readmissions and A&E attendances.ConclusionsLinkage between cohort studies such as ALSPAC and HES data provides unique opportunities for detailed insights into socio-demographic and other determinants of hospital activity, which can inform secondary care demand management in the NHS.

Cancer care in Poland: Activity and spending analysis as a forerunner to oncology reform

AimsTo analyse the current expenditure on cancer services in Poland and the pattern of spending and to estimate the number of patients with cancer who use public healthcare services. Materials and methodsWe analysed all healthcare services funded by National Health Fund (NHF) in Poland, collected in central database, together with each individual social security number (PESEL). From the database we selected all healthcare services whose primary diagnosis for a given service indicated cancer i.e. it was contained within C00-D09, D37-48 or Z51 (with a corresponding C or D) of ICD-10 classification. For comparison of hospital inpatient activity we analysed aggregate data from England (NHS Hospital Episode Statistics) and Australia (AIHW). ResultsCancer spending in Poland was PLN 6.3 billion in 2011 and PLN 6.6 billion in 2012, accounting for 6% of total healthcare spending and 10.4% of NHF operating budget. Within the current system only 8% of spending is on ambulatory care and only 39% of admissions are day cases. Excessive inpatient hospitalisation in chemotherapy, radiotherapy and for diagnosis accounts for PLN 1.4 billion or 23% of total cancer spending. Poland has more inpatient bed days (5.3 million vs. 3.2 million for England), even though it has half the reported cancer incidence. ConclusionsHealth providers’ behaviour is economically rational and driven by the current modalities of healthcare service financing in Poland. It will be shown that the share of healthcare spending for cancer care is about the same as in other countries however the structure of spending is different. At the same time it is a huge window of opportunity to restructure the financing mechanism for oncology in Poland. At the end of article we present how the planned reform of oncological care in Poland will change the economical incentives for providers and the expected results of it.

Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data.

ObjectiveTo describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC) and associated healthcare costs in English hospitals.DesignRetrospective cohort study.SettingAnalysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals.PatientsAdult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab.OutcomesFrequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits).Results191 UC patients completed adalimumab treatment induction. 83 (43.46%) dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing) (median time to dose escalation: 139 days). 56 patients (67.47%) subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days). Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351). Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients).ConclusionsWithin the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems.

Association between market concentration of hospitals and patient health gain following hip replacement surgery.

ObjectivesTo assess the association between market concentration of hospitals (as a proxy for competition) and patient-reported health gains after elective primary hip replacement surgery.MethodsPatient Reported Outcome Measures data linked to NHS Hospital Episode Statistics in England in 2011/12 were used to analyse the association between market concentration of hospitals measured by the Herfindahl-Hirschman Index (HHI) and health gains for 337 hospitals.ResultsThe association between market concentration and patient gain in health status measured by the change in Oxford Hip Score (OHS) after primary hip replacement surgery was not statistically significant at the 5% level both for the average patient and for those with more than average severity of hip disease (OHS worse than average). For 12,583 (49.1%) patients with an OHS before hip replacement surgery better than the mean, a one standard deviation increase in the HHI, equivalent to a reduction of about one hospital in the local market, was associated with a 0.104 decrease in patients’ self-reported improvement in OHS after surgery, but this was not statistically significant at the 5% level.ConclusionsHospital market concentration (as a proxy for competition) appears to have no significant influence (at the 5% level) on the outcome of elective primary hip replacement. The generalizability of this finding needs to be investigated.

Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England, 2001–2009

To calculate mortality of people with eating disorders (ED) in England, relative to that of people of the same age and sex, between 2001 and 2009. We were specifically interested in mortality amongst adolescents and young adults (15-24 years), and older adults (25-44 years). We analyzed a NHS Hospital Episode Statistics (HES) dataset for all England, linked to death registrations, to calculate age- and sex-specific discharge rates for people with a diagnosis of ED and their subsequent mortality by one year after discharge. The standardized mortality ratio (SMR) for adolescents and young adults with a diagnosis of ED was 7.8 (95% confidence interval: 4.4-11.2). This compares with an SMR for people of the same age with schizophrenia of 10.2 (8.3-12.2), with bipolar disorder of 3.6 (1.1-6.1, and with depression of 4.5 (3.6-5.3). Of the ED, the SMR for anorexia nervosa (AN) in people aged 15-24 was 11.5 (6.0-17.0), for bulimia nervosa (BN) was 4.1 (0-8.7), and eating disorders not otherwise specified (ED NOS) was 1.4 (0-4.0). For older adults aged 25-44 years, the SMR for ED was 10.7 (7.7-13.6). Specifically, for AN was 14.0 (9.2-18.8), for BN was 7.7 (3.5-11.9), and ED NOS was 4.7 (1.4-8.0), for schizophrenia was 7.3 (6.6-7.9), for bipolar disorder was 4.3 (3.5-5.1) and for depression was 4.9 (4.6-5.3). No deaths were recorded below 15 years of age. This study confirms the high SMR associated with ED, notably with anorexia and bulimia.

PSY14 Long-Term Medical Costs and Life Expectancy of Acute Myeloid Leukaemia: A Probabilistic Decision Model

Acute Myeloid Leukaemia (AML) can be diagnosed at any age and accounts for approximately one third of all leukaemia diagnoses. Treatment, which can be given with supportive and/or curative intent, is considered expensive compared to other cancers. Despite this, no long-term predictive models have been developed for AML, mainly due to the complexities associated with this disease. Thus, the aim of the current study was to develop an AML model (based on a UK cohort) that would allow cost and life expectancy results to be expressed at population level. The model developed in this study combined a decision tree with several Markov models. This was in order to reflect the complexity of health states, treatments, and prognostic factors (such as age and response to chemotherapy) of AML. The model was simulated over a life cycle of 60 months and results were contrasted between two age-groups and over different treatment pathways. Probabilistic modelling was also implemented in order to capture the potential uncertainties of input parameters. Transition probabilities, life expectancies and costs were derived from the NHS Hospital Episode Statistics (HES) and a UK population-based database from the Haematological Malignancy Research Network (HMRN, www.hmrn.org). The expected five year medical cost and life expectancy for the elderly patients (>60) were £22,538 and 8.5 months respectively, and for the young adult patients (18-60) £82,266 and 33.78 months respectively. The model was validated by the fact that the predicted results captured 92% of the actual costs, while it also demonstrated good fit of the actual survival outcomes. Costs and life expectancy of AML vary according to patient characteristics and treatment pathways. It is expected that future application of the AML model developed in this study could be used to evaluate new diagnostic tools/treatments and to support health care decision makers.

Validating self-reported strokes in a longitudinal UK cohort study (Whitehall II): Extracting information from hospital medical records versus the Hospital Episode Statistics database

BackgroundValuable information on the determinants of non-fatal stroke can be obtained from longitudinal observational cohort studies. Such studies often rely on self-reported stroke events, which are best validated with external medical evidence. The aim of this paper is to compare the information on incident non-fatal stroke events arising from different sources.MethodsWe carried out a validation of self-reported stoke events among participants in the Whitehall II Study, a large UK based cohort study (baseline sample size 10,308 men and women).Results106 stroke events were self-reported in three self-administered questionnaires between 2002 and 2009. Eight (7.5%) of these events were discarded as false positives after medical review, 66 were validated by information from the NHS Hospital Episode Statistics (HES) database in England, 16 by manual searches of hospital records alone, and 12 by letters from general practitioners alone. HES provided information on an additional (i.e. not self-reported) 47 events coded as stroke during the period 2002 to 2009 in hospitals in England among the original baseline participants. Of these, 43 participants were no longer active in the study and 4 had completed questionnaires but not reported a stroke event.ConclusionsValidating self-reported strokes in cohort studies with information from the NHS HES database was efficient and provided information on probable non-fatal stroke events among cohort members no longer in active follow-up. Manual extraction from hospital notes can provide supplementary information beyond that available in the HES discharge summary and was used to sub-type some strokes. However, the process was labour intensive. Multiple sources are needed to capture maximum information on stroke events but increasingly with hospitalisation in the acute phase of stroke, HES has an important role. Further development of HES is required to assure validity and coverage.