Post-acute Costs Research Articles

Cost of home hospitalization versus inpatient hospitalization inclusive of a 30-day post-acute period.

Previous studies have demonstrated that hospital at home (HaH) care is associated with lower costs than traditional hospital care. Most prior studies were small, not U.S.-focused, or did not include post-acute costs in their analyses. Our objective was to determine if combined acute and 30-day post-acute costs of care were lower for HaH patients compared to inpatient comparisons in a Center for Medicare and Medicaid Innovation Center demonstration of HaH. A single-center New York City retrospective observational cohort study of patients admitted to either HaH or inpatient care from September 1, 2014 through August 31, 2017. Eligible patients were 18 years or older, required inpatient admission, lived in Manhattan, and met home safety requirements. Comparison individuals met the same criteria and were included if they refused HaH care or were admitted when HaH was not available. HaH care was substitutive hospital-level care and 30-days of post-acute transitional care. Main outcomes were costs of care of the acute and post-acute 30-day episodes. We matched subjects on age, sex, and insurance and conducted regression analyses using an unadjusted model and one adjusted for several patient characteristics. Of 523 Medicare admission episodes, data were available for 201 episodes in the HaH arm and 101 episodes of usual care. HaH patients were older (81.6 [SD=12.3] years vs. 74.6 [SD=14.0], p < 0.0001) and more likely to have activities of daily living (ADL) impairments (75.4% vs. 46.5%, p < 0.0001). Unadjusted mean costs were $5054 lower for HaH episodes compared to inpatient episodes. Regression analysis with matching showed HaH costs were $5116 (95% CI -$10,262 to $30, p=0.05) lower, and when adjusted for age, sex, insurance, diagnosis, and ADL impairments, $5977 (95% CI -$10,758 to -$1196, p=0.01) lower. HaH combined with 30-day post-acute transition care was less costly than inpatient care.

Can a Reduction in Revision Rates Make Robotic Total Knee Arthroplasty Cost Neutral With Manual Total Knee Arthroplasty at Ten-Year Follow-Up? An Episode Cost Analysis

BackgroundAdvocates of robotic total knee arthroplasty (RTKA) suggest that its greater cost may be recaptured through a reduction in revision rates. We sought to determine what reduction in revision TKA would be required for RTKA to become cost neutral with manual TKA (MTKA). MethodsEpisode costs were determined for 2392 RTKAs and 2392 MTKAs. Mean total cost of revision TKA in our health system was identified. Episode cost difference of the RTKA and MTKA cohorts was divided by the mean cost of revision TKA to estimate the reduction in revisions required to make RTKA cost neutral with MTKA. The National Joint Registry was consulted to determine the cumulative revision rate for the implant used in this study. ResultsEpisode cost for the RTKA cohort was $5.7M greater than MTKA. Mean acute stay cost for revision TKA was $20,972, but post-acute costs were not available. If post-acute costs for revision TKA are conservatively estimated at 50% of episode cost (ie, episode cost = $41,944), 131 revision TKAs would need to be prevented in the RTKA cohort to make it cost neutral with MTKA. The National Joint Registry cumulative revision rate for this implant is 3.37% at 10 years, thus only 81 revisions would be expected per cohort. ConclusionOur data suggest that it is not possible for RTKA to achieve cost parity with MTKA through a reduction in revision rate alone. Future price reductions may make the cost comparison more favorable. In addition, demonstration of improved patient outcomes would undeniably add value to RTKA and change the analysis.

Outpatient surgery for the inpatient: an introduction to postacute care.

This article considers how postacute care (PAC) facilities such as skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals could represent an opportunity for outpatient surgical facilities to improve patient care. In order to understand how these facilities interact with outpatient surgical services, it is first necessary to understand the types of facilities that provide PAC. The significant costs associated with PAC have led to some proposed regulatory changes. Evidence examining postacute costs following total joint replacement has indicated that these costs may be decreased with cooperative efforts between perioperative physicians and PAC facilities. However, the lack of currently published data on the interaction between outpatient surgery and inpatient PAC facilities creates a need to explore how greater cooperation between these types of facilities could lead to improvements in patient care. PAC facilities are inpatient facilities focused on the rehabilitation of patients recovering from an acute illness or surgical intervention. This article seeks to provide ambulatory practitioners a fundamental understanding of PAC as a starting point for future collaborative efforts with PAC facilities; improving care for patients referred to and from PAC facilities for outpatient surgical care.

Estimation of long-term costs of postacute care in survivors of the methanol poisoning outbreak

ObjectivesTo fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated.DesignIn...

Abstract P295: The Effect of Endovascular Procedure and Tissue Plasminogen Activator Treatments on 90 Days Episode Payments Among Ischemic Stroke Patients

Introduction: Endovascular therapy (EVT) and tissue plasminogen activator (tPA) are highly effective treatments but little is published on their impact on health care utilization and payments. We analyzed of data from the Michigan Value Collaborative (MVC) registry to compare 90-day episode payments for EVT and tPA treatments acute ischemic stroke patients. Methods: The MVC registry uses claims data from Michigan residents insured by Medicare fee-for-service and Blue Cross Blue Shield, to construct risk-adjusted and price-standardized payments for 90-day episodes of care. Total payments are categorized into index hospitalization, professional services, readmissions, and post-acute care. All ischemic stroke admissions between January 2014 and June 2019 were identified and then categorized using a combination of diagnosis and procedure codes into 3 mutually exclusive treatment groups: EVT (with and without tPA), IV or IA tPA only, and all other ischemic strokes (non EVT-tPA). We compared 90-day episode payments between the 3 groups using analysis of variance and Tukey’s pairwise comparisons. Results: We identified 47,235 acute ischemic stroke patients admitted to 83 Michigan hospitals, 1,775 (3.8%), 4,889 (10.3%), and 40,571 (85.9%) received EVT, tPA only, or neither, respectively. Statistically significant differences were observed across the 3 treatment groups in all payment categories. EVT treated patients had the highest 90-day mean payments in all categories, but particularly for readmissions and post-acute care (Table). tPA treated patients had significantly higher costs than the non EVT-tPA group for total payments, professional and hospitalization fees. Conclusions: EVT and tPA treatments significantly affect 90-day episode payments - primarily due to higher hospitalization and professional payments. Higher readmission and post-acute cost in EVT treated patients reflect higher readmission rates and use of in-patient rehabilitation.

Cost Determinants of Continuum-Care Episodes for Hip Fracture.

Many factors affect the healthcare costs and outcomes in patients with hip fracture (HF). Through the construction of a Continuum-Care Episode (CCE), we investigated the costs of CCEs for HF and their determinants. We used data extracted from administrative databases of 5094 consecutive elderly patients hospitalized in 2017 in Emilia Romagna, Italy, to evaluate the overall costs of the CCE. We calculated the acute and post-acute costs from the date of the hospital admission to the end of the CCE. The determinants of costs by type of surgical intervention (total hip replacement, partial hip replacement, open reduction, and internal fixation) were investigated using generalized linear regression models. Regardless of the type of surgical intervention, hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds or not were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs. CCE’s cost and its variability is mainly related to the rehabilitation setting. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with lower overall costs. Intermediate care organizational setting should be privileged when planning integrated care HF pathways.

Abstract WP356: Unbundling Care Transitions and Cost After Stroke: Results From the BPCI-Advanced Program

Introduction: The Centers for Medicare and Medicaid Services bundled payment for care improvement advanced (BPCI-A) program incentivizes providers to better coordinate care, reduce expenses, and improve quality. The purpose of this study was to determine the impact of improving post-acute care coordination after stroke on quality and resource utilization in the BPCI-A program. Methods: Capital Health collaborated with post-acute providers to improve communication, identify criteria for early supported discharge to the community, expedite home health and outpatient services, reduce readmissions, and initiate advanced care planning. The redesigned post-acute care coordination program was implemented at Capital Health’s primary and comprehensive stroke center. Quality outcomes and resource utilization measures for patients enrolled in the BCPI-A program were compared to BPCI-A eligible patients prior to program implementation. Results: Forty-three patients enrolled in the BCPI-A program were compared to 77 patients eligible for enrollment. Clinical and demographic characteristics were similar (p&gt;.05). After program implementation, 21.5% fewer patients were discharged to an inpatient rehabilitation facility (p=.024) and 14% more patients were discharged to inpatient hospice (p&lt;.001). On average, post-acute cost decreased $16,608 per patient (p=.007) resulting in a $16,820 reduction in the 90-day cost per episode (p=.011). The 90-day hospital readmission rate decreased insignificantly by 14.1% from 23.4% to 9.3% (p=.056). Hospital cost, hospital length of stay and the 90-day mortality rate were unchanged (p&gt;.05). Conclusion: The coordination of post-acute services facilitates care transitions after stroke. The identification of patients meeting criteria for early supported discharge to the community or admission to inpatient hospice helped reduce post-acute cost without increasing 90-day readmission or mortality.

Multifaceted Care Model for CHF Improves Health System and Patient Economic Outcome

Introduction Inconsistent piece-meal care for a chronic multidimensional disease like CHF results in poor clinical outcomes, therefore a chronic disease Care model that provides multifaceted holistic chronic disease management in the post-acute setting, aligning a multidisciplinary dedicated heart care team to a narrow network of home/community service providers implementing evidence based protocols across the continuum; namely a Care pathway improves outcomes. Specifically, this pathway may include daily inpatient CHF identification and navigation as follows: Heart protocol implementation & training at exclusively partnered Skilled Nursing/LTAC/Home Health after concerted CHF Education (at those facilities) of Nurse practitioners (32 hours) RN Aides (3 hours) and RN (6 hours) of evidence based curriculum.Participating in daily phone huddle along with daily telehealth from the partnered facilities and home health with daily reporting/monitoring of progress eg., vitals, diet, PT/OT progress, etc.Incorporating care of chronic comorbidities including Diabetes and COPD and working concomitantly with those Care pathways.Discharge planning under the supervision of central CRNP and multi-disciplinary team including physician follow-up The above model and it's pathways revealed improvement in clinical outcomes, particularly 30 day readmissions that were reported at the HFSA 2018 but the economic impact of such interventions are unknown. Hypothesis The above mentioned comprehensive approach to HF and it's proven improved clinical outcomes may also translate into economic savings. Methods A total of 1982 Allegheny Health/Highmark (AHN) patients are on the above mentioned Care pathway, out of which 337 were identified (from May 2017 until Dec 2018) as possible matches to patients outside of the system (deemed as “Market”) with similar attributes such as clinical severity, comorbidities and index facility ie., tertiary vs. community hospitals. The above match was blinded and performed by an independent non clinical entity to maintain investigational integrity. Results After placement on the pathway, patient cost defined as per member per month (PMPM) was less expensive than market by $357 primarily driven by 30% decrease in post discharge inpatient cost and 12% decrease in post-acute costs (see Fig 1). Conclusion Economic benefit can be achieved in tandem with better clinical outcome via multifaceted CHF care.

Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications, Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty?

BackgroundNursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA). MethodsAll SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims. ResultsFour hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P = .01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P = .02) but was similarly not predictive of 90-day readmission/complications. ConclusionResults of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system.

Global Budget Revenue on a Single Institution’s Costs, Outcomes, and Patient Quality Metrics in Patients Undergoing Total Knee Arthroplasty

BackgroundMaryland was granted a waiver to implement a Global Budget Revenue (GBR) reimbursement model. Statewide results for combined medical and surgical services have been reported for fiscal years 2015 and 2016. A paucity of studies exists exploring the change in care costs and outcomes for total knee arthroplasty (TKA) recipients under GBR. This study aims to assess the effects of GBR on cost of care and resource utilization related to TKA at a single institution before and after GBR. MethodsThe Maryland Center for Medicare and Medicaid Services database was used to find Medicare patients who underwent TKA at a single institution before (2012-2013) and after (2014-2015) GBR. A total of 150 and 161 TKAs were performed in 2012 and 2015. Cost differences were compared for each inpatient care episode, postacute care period, and readmissions. We also evaluated differences in length of stay, discharge disposition, and complication rates. ResultsMean inpatient cost was significantly lower in 2015 vs 2012 (P = .0014); however, analysis of postacute costs showed a nonsignificant increase in price between years (P = .1008). We demonstrated significant increase in home health (P < .0001) and significant decrease in acute rehabilitation (P = .0481). Durable medical equipment costs significantly decreased (P = .0087). ConclusionWe demonstrate lower mean inpatient costs since GBR initiation. We reveal increased mean postacute care costs, which may be due to increased acuity for patients needing postacute care. Our results show nonsignificant reductions in length of stay, complications, and increased rate of home discharge, suggesting GBR may be effective in orchestrating reduced costs for TKA at high-volume institutions.

Concentration of Potentially Preventable Spending Among High-Cost Medicare Subpopulations: An Observational Study.

Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries. To determine the proportion of total spending that is potentially preventable across distinct subpopulations of high-cost Medicare beneficiaries. Beneficiaries in the highest 10% of total standardized individual spending were defined as "high-cost" patients, using a 20% sample of Medicare fee-for-service claims from 2012. The following 6 subpopulations were defined using a claims-based algorithm: nonelderly disabled, frail elderly, major complex chronic, minor complex chronic, simple chronic, and relatively healthy. Potentially preventable spending was calculated by summing costs for avoidable emergency department visits using the Billings algorithm plus inpatient and associated 30-day postacute costs for ambulatory care-sensitive conditions (ACSCs). The amount and proportion of potentially preventable spending were then compared across the high-cost subpopulations and by individual ACSCs. Medicare. 6112450 Medicare beneficiaries. Proportion of spending deemed potentially preventable. In 2012, 4.8% of Medicare spending was potentially preventable, of which 73.8% was incurred by high-cost patients. Despite making up only 4% of the Medicare population, high-cost frail elderly persons accounted for 43.9% of total potentially preventable spending ($6593 per person). High-cost nonelderly disabled persons accounted for 14.8% of potentially preventable spending ($3421 per person) and the major complex chronic group for 11.2% ($3327 per person). Frail elderly persons accounted for most spending related to admissions for urinary tract infections, dehydration, heart failure, and bacterial pneumonia. Potential misclassification in the identification of preventable spending and lack of detailed clinical data in administrative claims. Potentially preventable spending varied across Medicare subpopulations, with the majority concentrated among frail elderly persons. The Commonwealth Fund.

A Retrospective Study to Examine Healthcare Costs Related to Cardiovascular Events in Individuals with Hyperlipidemia.

IntroductionFew studies have demonstrated the cost burden of cardiovascular events (CVEs) among patients with hyperlipidemia. The primary objective of this study was to determine the mean costs associated with CVEs among patients with hyperlipidemia by follow-up time period. Secondary objectives of this study included characterizing costs by CVE type and coronary heart disease (CHD) risk.MethodsThis retrospective cohort study used longitudinal claims to calculate payer costs according to CHD risk level and type of CVE, during several follow-up periods (acute and short-term, comprising year 1; plus years 2 and 3).ResultsThere were 193,385 patients with hyperlipidemia with a CVE. Costs in the acute (30-day) period were highest ($22,404) driven by inpatient care (77%). Costs remained high ($15,133 in year 3) with ambulatory care (from 14% in acute to 37% in year 3) and pharmaceutical costs (from 2% in acute to 24% in year 3) representing a greater proportion. After second and third CVEs, acute costs were lower than for the first CVE. But in the post-acute periods, costs were higher after second and third CVEs than after first CVEs. Acute costs varied considerably by type of CVE ($9149 for transient ischemic attack to $54,251 for coronary artery bypass graft; P < 0.001), but post-acute costs were more similar across types. Costs differed by baseline CHD risk for all follow-up periods (P < 0.001), but less than by CVE type. As expected, patients without CVEs had significantly lower costs.ConclusionAmong patients with hyperlipidemia, the economic burden of CVEs is substantial up to 3 years after a CVE. Costs remain high after subsequent CVEs and actually increase for non-inpatient utilization.FundingAmgen Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0264-7) contains supplementary material, which is available to authorized users.

Explaining the Health Costs Associated with Managing Intracranial Aneurysms in Italy

The clinical management of intracranial aneurysms is debated in many countries because of the associated disability risk and costs. Therefore, estimating the costs and explaining their variability will provide important information for decision makers. We aimed to evaluate the acute and post-acute health costs of intracranial aneurysm management and to explain the variability in these costs in the Italian National Health System. An observational study was conducted on 145 patients who were affected by a (single) ruptured or an unruptured intracranial aneurysm. They were consecutively admitted to 14 Italian hospitals between October 2005 and March 2007. The data collected during the initial hospitalization and three follow-up visits were used to assess the 1-year health costs and the patients' health status after discharge. Two multivariate regression models were used to explain the variability in the acute and post-acute costs. The average total cost per patient was <euro>30,813 (evaluation year: 2012). The first model explained the acute costs fairly well and showed that the severity of illness, the admission unit (i.e., intensive care unit vs. another unit of the hospital), and mortality were associated with large, significant (p < 0.05) coefficients. The second model outperformed the first one in explaining the post-acute costs and showed that health status assessed 30 days after discharge was a significant (p < 0.05) predictor of costs. Policies aimed at containing health costs should focus on interventions that help to reduce disability, which is a key predictor of long-term costs.

Abstract 157: The Relationship between Readmission Cost and Total Cost Over Time for Heart Failure

Background: The dominant healthcare payment model in the US, fee-for-service, provides incentives to deliver costlier care for heart failure and disincentives to deliver higher quality care. One proposed method to align cost and quality incentives is to impose financial penalties on providers when patients are readmitted within 30 days after a heart failure hospitalization. We hypothesized that this strategy might not lower overall costs, because lower readmission costs might be offset by higher non-readmission post-acute care costs. Methods: We studied cost to Medicare from 2008-09 for all heart failure hospitalizations (MS-DRG 291, 292, or 293) in the 15 healthcare delivery systems participating in the High Value Health Collaborative. We categorized costs for the 30, 90, and 180 days after the day of admission for first heart failure hospitalization in the study period into acute care costs (inpatient care, outpatient facility costs with 3 day look back window, part B professional fees), inpatient readmission cost, and non-readmission post-acute care costs (outpatient facility fee, sub-acute rehab, inpatient rehab, long term care, home health care, part B professional fees). Results: Using the most common MS DRG (DRG 292) as an example, across the 15 healthcare systems, we found wide variation in median total costs for the 30- ($6487-$11565), 90- ($8049-$18918), and 180- ($9844-$24752) day time frames. For the 30-day time frame, readmission costs ($700 - $2684) and non-readmission post-acute care costs ($477 - $6398) also showed wide variation. The Figure is a plot of these two costs, with bubbles sized to reflect the number of cases for the hospital system (30-day time frame); results were comparable for 90 and 180 days. Contrary to our hypothesis, we found no inverse relationship between readmission costs and non-readmission post-acute care costs. These data do not account for possible differences in case mix and in geographic differences in labor and facility costs. Conclusions: Non-readmission post-acute costs for heart failure are unrelated to readmission costs but were greater than readmission costs in a number of healthcare deliver systems, raising questions about the overall value to the healthcare systems of an exclusive focus on readmission as a strategy for reducing the costs of heart failure.

The future cost of stroke in Ireland: an analysis of the potential impact of demographic change and implementation of evidence-based therapies

this paper examines the impact of demographic change from 2007 to 2021 on the total cost of stroke in Ireland and analyses potential impacts of expanded access to stroke unit care and thrombolytic therapy on stroke outcomes and costs. total costs of stroke are estimated for the projected number of stroke cases in 2021 in Ireland. Analysis also estimates the potential number of deaths or institutionalised cases averted among incident stroke cases in Ireland in 2007 at different rates of access to stroke unit care and thrombolytic therapy. Drawing on these results, total stroke costs in Ireland in 2007 are recalculated on the basis of the revised numbers of incident stroke patients estimated to survive stroke, and of the numbers estimated to reside at home rather than in a nursing home in the context of expanded access to stroke units or thrombolytic therapy. future costs of stroke in Ireland are estimated to increase by 52-57% between 2007 and 2021 on the basis of demographic change. The projected increase in aggregate stroke costs for all incident cases in 1 year in Ireland due to the delivery of stroke unit care and thrombolytic therapy can be offset to some extent by reductions in nursing home and other post-acute costs.

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma

IntroductionThe costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. MethodsIn a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. ResultsThere were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044–6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50–6880). Low education standard (β coefficient: $5988, 95% CI: 822–13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426–9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766–18,334) were associated with increased post-acute costs. ConclusionIn a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied considerably. As long term morbidity is common in this population, a history of resolved neurologic deficit may require greater intervention to mitigate costs. Additionally, adequate communication between acute and community care providers is essential in order to expedite the recovery process through early return to normal daily activities.

Population-Based Study of Acute- and Long-Term Care Costs after Stroke in Patients with AF

New treatments for atrial fibrillation patients have been shown to be effective at reducing subsequent vascular event recurrence. However, there are few data on stroke costs in atrial fibrillation patients to allow the cost-effectiveness of these treatments to be assessed. Using data from a population-based study, we assessed the acute and long-term costs of stroke in atrial fibrillation patients. Health-care costs one-year before and five-years after stroke were obtained from a large population-based study (Oxford Vascular study). Costs were assessed for the three-months poststroke (acute period) and annually thereafter (postacute period). Annual postacute costs were compared with annual baseline costs. Based on patients' living arrangements, costs of institutionalization after the event were included. A total of 191 strokes occurred in 153 patients with known prior atrial fibrillation. Mean health-care costs after stroke were £10 413 (standard deviation 15 105) in the acute phase, with annual postacute health-care costs nonsignificantly smaller than those incurred before the event (£2400 vs. £3356, respectively; P = 0·198). However, for the 136 strokes surviving past the 90-day acute period, costs were nonsignificantly higher than those incurred in the year before the event (£3370 vs. £2566, respectively; P = 0·333). After stroke, 25 (13%) patients were newly admitted into long-term warden, nursing, or residential care, resulting in annual costs of £6880 (standard deviation 15 600) averaged across the 136 stroke cases surviving past the acute period. Although annual post acute phase hospital and primary health-care costs in stroke patients with prior atrial fibrillation were not significantly different to those incurred before the stroke, long-term nursing/residential care costs were substantial.

One-year treatment costs of trauma care in the USA

Although injuries are a leading cause of morbidity and mortality in the USA, few prior studies exist on the costs of trauma care. This article estimates treatment costs of care for 12 months following injury. Primary and secondary data were collected on over 5000 moderate-to-severely injured patients 18–84 years of age discharged from 69 US hospitals. Acute and post-acute costs of care were estimated from a combination of data sources: UB92 hospital bills, patient surveys, medical record abstracts, and where available, Medicare claims. Key analysis variables were demographic characteristics, insurance status and nature and severity of injury. Mean 1-year cost per patient of trauma care in our population was $75,210. On average, 58% of cost was accounted for by the index hospitalization. Total 1-year treatment cost of adult major trauma in the USA was conservatively estimated to be US$27 billion annually (2005).