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Che T, Li J, Li J, Chen X, Liao Z. Long-term care needs and hospitalization costs with long-term care insurance: a mixed-sectional study. Front Public Health 2024; 12:1226884. [PMID: 38651130 PMCID: PMC11034482 DOI: 10.3389/fpubh.2024.1226884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background With the rapid aging of the population, the health needs of the older adult have increased significantly, resulting in the frequent occurrence of the "social hospitalization" problem, which has led to a rapid increase in hospitalization costs. This study investigates whether the "social hospitalization problem" arising from the long-term care needs can be solved through the implementation of long-term care insurance, thereby improving the overall health of the older adults and controlling the unreasonable increase in hospitalization costs. Methods The entropy theory was used as a conceptual model, based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. The least-squares method was used to examine the relationship between long-term care needs and hospitalization costs, and the role that long-term care insurance implementation plays in its path of influence. Results The results of this study indicated that long-term care needs would increase hospitalization cost, which remained stable after a series of tests, such as replacing the core explanatory variables and introducing fixed effects. Through the intermediary effect test and mediated adjustment effect test, we found the action path of long-term care needs on hospitalization costs. Long-term care needs increases hospitalization costs through more hospitalizations. Long-term care insurance reduces hospitalization costs. Its specific action path makes long-term care insurance reduce hospitalization costs through a negative adjustment of the number of hospitalizations. Conclusion To achieve fair and sustainable development of long-term care insurance, the following points should be achieved: First, long-term care insurance should consider the prevention in advance and expand the scope of participation and coverage; Second, long-term care insurance should consider the control in the event and set moderate levels of treatment payments; Third, long-term care insurance should consider post-supervision and explore appropriate payment methods.
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Affiliation(s)
- Tiantian Che
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Jia Li
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Jun Li
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Xiaobo Chen
- School of Investment Project Management, Dongbei University of Finance and Economics, Dalian, China
| | - Zangyi Liao
- School of Political Science and Public Administration, China University of Political Science and Law, Beijing, China
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Kalra A, Ruck JM, Zhou AL, Akbar AF, Shou BL, Casillan AJ, Ha JS, Merlo CA, Bush EL. Bigger pies, bigger slices: Increased hospitalization costs for lung transplantation recipients in the non-donation service area allocation era. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00103-X. [PMID: 38678473 DOI: 10.1016/j.jtcvs.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE On November 24, 2017, lung transplant allocation switched from donation service area to a 250-nautical mile radius policy to improve equity in access to lung transplantation. Given the growing consideration of healthcare costs, we evaluated changes in hospitalization costs after this policy change. METHODS Lung transplant hospitalizations were identified within the National Inpatient Sample from 2005 to 2020. Recipients were categorized as donation service area era (August 2015 to October 2017) or non-donation service area era (December 2017 to February 2020). Median total hospitalization costs (inflation adjusted) were compared by era nationally and regionally. Multivariable generalized linear regression was performed to determine if the removal of the donation service area was associated with total hospitalization costs. The model was adjusted for recipient demographics, Charlson Comorbidity Index, hospitalization region, transplant type (single, double), and use of extracorporeal membrane oxygenation, ex vivo lung perfusion, and mechanical ventilation. RESULTS We analyzed 12,985 lung transplant recipients (median age of 61 years, 66% were male): 7070 in the donation service area era and 5915 in the non-donation service area era. Demographics were not different between recipients in both eras. Non-donation service area era recipients had greater extracorporeal membrane oxygenation use, mechanical ventilation (<24 hours), and longer length of stay than donation service area era recipients. Median total hospitalization costs for non-donation service area versus donation service area era recipients increased by $24,198 ($157,964 vs $182,162, percentage change = 15.32%, P < .001). Median costs increased in East North Central ($42,281) and Mountain ($35,521) regions (both P < .01). After adjustment, median costs for non-donation service area versus donation service area era recipients still increased ($19,168, 95% CI, 145-38,191, P = .048). CONCLUSIONS Hospitalization costs for lung transplant hospitalizations have increased from 2015 to 2020. The transition from donation service area-based allocation to the non-donation service area system may have contributed to this increase after 2017 by increasing access to transplant for sicker recipients.
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Affiliation(s)
- Andrew Kalra
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Jessica M Ruck
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alice L Zhou
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Armaan F Akbar
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Benjamin L Shou
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alfred J Casillan
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jinny S Ha
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Errol L Bush
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
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Gao J, Liu Y. Prediction and the influencing factor study of colorectal cancer hospitalization costs in China based on machine learning-random forest and support vector regression: a retrospective study. Front Public Health 2024; 12:1211220. [PMID: 38389946 PMCID: PMC10881792 DOI: 10.3389/fpubh.2024.1211220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Aims As people's standard of living improves, the incidence of colorectal cancer is increasing, and colorectal cancer hospitalization costs are relatively high. Therefore, predicting the cost of hospitalization for colorectal cancer patients can provide guidance for controlling healthcare costs and for the development of related policies. Methods This study used the first page of medical record data on colorectal cancer inpatient cases of a tertiary first-class hospital in Shenzhen from 2018 to 2022. The impacting factors of hospitalization costs for colorectal cancer were analyzed. Random forest and support vector regression models were used to establish predictive models of the cost of hospitalization for colorectal cancer patients and to compare and evaluate. Results In colorectal cancer inpatients, major procedures, length of stay, level of procedure, Charlson comorbidity index, age, and medical payment method were the important influencing factors. In terms of the test set, the R2 of the Random forest model was 0.833, the R2 of the Support vector regression model was 0.824; the root mean square error (RMSE) of the Random forest model was 0.029, and the RMSE of the Support vector regression model was 0.032. In the Random Forest model, the weight of the major procedure was the highest (0.286). Conclusion Major procedures and length of stay have the greatest impacts on hospital costs for colorectal cancer patients. The random forest model is a better method to predict the hospitalization costs for colorectal cancer patients than the support vector regression.
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Affiliation(s)
- Jun Gao
- Department of Medical Record Statistics, Peking University Shenzhen Hospital, Shenzhen, China
- School of Public Healthy, Guilin Medical University, Guilin, China
| | - Yan Liu
- Department of Medical Record Statistics, Peking University Shenzhen Hospital, Shenzhen, China
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Peng N, He Q, Bai J, Chen C, Liu GG. Hospitalization Costs for Patients with Acute Appendicitis: An Update Using Real-World Data from a Large Province in China. Risk Manag Healthc Policy 2023; 16:2805-2817. [PMID: 38145209 PMCID: PMC10748862 DOI: 10.2147/rmhp.s436853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose The aim of this study is to investigate the factors influencing hospitalization costs for patients diagnosed with acute appendicitis in China. Methods We conducted a cross-sectional study using data from Provincial Health Statistics Support System Database from S Province in China. This dataset contained all hospital's electronic medical records from January 1, 2015 to December 31, 2018 including both public and private hospitals. The target population was identified based on the principal diagnosis of appendicitis (ICD-10: K35). To examine the impact of various factors on hospitalization costs, we conducted a multivariate linear regression analysis. Furthermore, we employed the Shapley value decomposition method to gain a more comprehensive understanding of the factors that influenced hospitalization costs and their respective levels of importance. Results Our study comprised 317,200 cases. During the period from 2015 to 2018, the average hospitalization expenses for patients with acute appendicitis were estimated at approximately 7014 RMB (1061 USD), which accounts for a considerable 12% of China's per capita GDP. The results of this study demonstrate a significant correlation between various factors, such as the patient's age, gender, marital status, occupation, payment method, number of complications, treatment method, hospital tier, and ownership, and the total hospitalization costs and subcomponents of hospitalization costs. Notably, the treatment method employed had the most substantial impact on hospitalization costs. Conclusion To the best of knowledge, this is one of the first studies to investigate the hospitalization costs of acute appendicitis incorporating both patient-level and hospital-level covariates, using a large sample size. To reduce the costs associated with acute appendicitis in China, it is recommended to consider suitable treatment options and explore the option of receiving medical care at lower-tier and privately-owned healthcare facilities.
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Affiliation(s)
- Nan Peng
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, 211198, People’s Republic of China
| | - Qinghong He
- Institute of Economics, Chinese Academy of Social Sciences, Beijing, 100836, People’s Republic of China
| | - Jie Bai
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, 211198, People’s Republic of China
| | - Chen Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, 430071, People’s Republic of China
| | - Gordon G Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, 211198, People’s Republic of China
- Institute for Global Health and Development, Peking University, Beijing, 100080, People’s Republic of China
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Yan S, Zhang X, Zhang S, Wang Z, Dai Z, Zhou X, Liu J, Li B, Liu J. Influence of Inflammatory Bowel Disease on Patients Undergoing Primary Total Joint Arthroplasty: A Systematic Review and Meta-analysis of Cohort Studies. Orthop J Sports Med 2023; 11:23259671231205541. [PMID: 37941887 PMCID: PMC10629331 DOI: 10.1177/23259671231205541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 11/10/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is recognized as a global disease. Although IBD is commonly diagnosed in the young male population, it also occurs in patients aged >60 years. With the advent of an aging society, it is expected that an increasing number of patients with IBD will undergo total joint arthroplasty (TJA). Purpose To assess the impact of IBD on the risk of complications and revision as well as the length of stay (LOS) and treatment costs after TJA. Study Design Systematic review; Level of evidence, 4. Methods Utilizing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles were searched in the PubMed/MEDLINE, Embase, and Cochrane Library databases from the date of inception to August 31, 2022, using the following search terms: (1) "Inflammatory Bowel Diseases"[MeSH] and (2) "Arthroplasty, Replacement"[MeSH]. The study quality was scored according to the Newcastle-Ottawa Scale. A fixed-effects or random-effects model was used to calculate odds ratios or mean differences with 95% confidence intervals. Results Of 232 studies initially retrieved, 8 retrospective cohort studies consisting of 33,758 patients with IBD and 386,238 patients without IBD were included. Patients with IBD had a higher incidence of complications (P < .05), readmission and revision (P < .05), experienced a longer LOS (P < .01), and paid higher treatment costs after TJA compared with patients without IBD . Conclusion The results of our review demonstrated that IBD increased the risk of postoperative complications, prolonged the LOS, and increased treatment costs.
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Affiliation(s)
- Shuo Yan
- Tianjin Union Medical Center, Nankai University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Xiaofei Zhang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Shuhao Zhang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Zheng Wang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Zhengxu Dai
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Xuyang Zhou
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Jianchao Liu
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Department of Joints, Tianjin Hospital, Tianjin, China
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Dervaux B, Van Berleere M, Lenne X, Wyckaert M, Dubos F. Impact of RSV test positivity, patient characteristics, and treatment characteristics on the cost of hospitalization for acute bronchiolitis in a French university medical center (2010-2015). Front Pediatr 2023; 11:1126229. [PMID: 37528879 PMCID: PMC10390249 DOI: 10.3389/fped.2023.1126229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background In young children, respiratory syncytial virus (RSV)-related bronchiolitis is typically more severe than other respiratory tract infections, with a greater need for oxygen therapy and respiratory support. Few studies have compared the cost of hospitalization with regard to virological status. The objective of this study was to compare the costs of hospitalization for RSV-positive vs. RSV-negative bronchiolitis in a French university medical center between 2010 and 2015. Methods The cost models were compared using conventional goodness-of-fit criteria. Covariates included the characteristics of the patients, pre-existing respiratory and non-respiratory comorbidities, superinfections, medical care provided, and the length of stay. Results RSV was detected in 679 (58.3%) of the 1,164 hospital stays by children under 2 years with virological data. Oxygen therapy and respiratory support were twice as frequent for the RSV-positive cases. The median hospitalization cost was estimated at €3,248.4 (interquartile range: €2,572.1). The cost distribution was positively skewed with a variation coefficient (CV = standard deviation/mean) greater than one (mean = €4,212.9, standard deviation = €5,047, CV = 1.2). In univariate analyses, there was no significant cost difference between the RSV-positive and RSV-negative cases. In the best multivariate model, the significant positive effect of RSV positivity on cost waned after the introduction of medical care variables and the length of stay. The results were sensitive to the specification of the model. Conclusions It was impossible to firmly conclude that hospitalization costs were higher for the RSV-positive cases.
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Affiliation(s)
- Benoit Dervaux
- CHU Lille, Direction de la Recherche et de l’Innovation, Lille, France
| | | | - Xavier Lenne
- CHU Lille, Département d’Information Médicale, Lille, France
| | - Marine Wyckaert
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
| | - François Dubos
- CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France
- Univ Lille, ULR 2694 - Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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Faur CI, Moldovan MA, Văleanu M, Rotar H, Filip L, Roman RC. The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center. Medicina (Kaunas) 2023; 59. [PMID: 36837422 DOI: 10.3390/medicina59020220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.
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Yan Y, Tu Y. The impact of China's urban and rural economic revitalization on the utilization of mental health inpatient services. Front Public Health 2023; 10:1043666. [PMID: 36711421 PMCID: PMC9877533 DOI: 10.3389/fpubh.2022.1043666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 01/13/2023] Open
Abstract
Background Rural locations have a lower preference for mental healthcare than urban areas. Medical and pharmacy expenses incurred as a result of serious mental illness are covered by public health insurance, according to the People's Republic of China's Mental Health Law. This study aimed to acknowledge the disparities in the use of mental health services provided by the government health schemes among the rural and urban populations of China and to assess the real reimbursement rates for health insurance coverage. It also sheds light on China's ongoing healthcare reforms for mental health treatments. Materials and methods A retrospective cohort study of patients was conducted that were hospitalized with mental illnesses to assess rural-urban disparities in the utilization of mental health services and the role of health insurance. We used electronic health data from the major psychiatric institutes for 15 years (2005-2020) to assess the influence of health insurance systems on Chinese public preferences for mental health treatments. These psychiatric hospitals serve almost 10% of all mental health patients every year in Shandong and accept patients from all over the country. In addition, health insurance policy regulations in Shandong Province are consistent with national health insurance policy regulations. Models 1 and 2 assess disparities in the utilization of mental health treatments. Our study population was identified using patients' primary diagnosis, as recorded in the two hospitals' EHRs, which routinely record information on patients' sociodemographic characteristics, clinical characteristics of the disease, cost of the treatment, and type of the health insurance plan. The record of EHR data is considered efficient because they document all inpatient expenses incurred during hospitalization in a detailed, itemized, and reliable way. Results Urban patients had longer hospital stays (p = 0.0001), more hospitalizations (p = 0.006), and greater hospitalization expenses (p = 0.001) than rural patients. Patients who had insurance had a longer hospital stay (p = 0.0001), more hospitalizations (p = 0.0001), and greater hospitalization costs (p = 0.0001) than those who did not have insurance. Urban residents used mental health services more than rural residents. People preferred mental healthcare when the reimbursement ratio variable was larger, especially in rural areas. Conclusion Rural people of China experience mental health services are an economic burden. Uniform measures are required to be taken for the development of health insurance policies for people in rural areas.
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Affiliation(s)
- Yu Yan
- School of Law, Guangdong University of Technology, Guangzhou, Guangdong, China,*Correspondence: Yu Yan
| | - Yongqian Tu
- National Academy of Development and Strategies, Renmin University of China, Beijing, China,Yongqian Tu
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Zeng Z, Li N, Yang L, Feng X, Zuo F, Luo G, Peng Y, Yuan Z. Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study. Front Public Health 2023; 10:1052293. [PMID: 36699890 PMCID: PMC9868295 DOI: 10.3389/fpubh.2022.1052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Background Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.
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Puthuraya S, Karnati S, Othman H, Sripathi R, Nandakumar V, Aly H. Neonatal outcomes of preterm infants with in-utero exposure to drugs of substance use: US national data. Pediatr Neonatol 2023; 64:53-60. [PMID: 36283910 DOI: 10.1016/j.pedneo.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Infants exposed prenatally to drugs of substance use are at increased risk for seizures, strabismus, feeding difficulty, and neurodevelopmental delays. Exposed preterm infants may have additional morbidities related to prematurity. There is limited literature on national outcomes of preterm infants exposed to drugs of substance use. We aimed to evaluate the trends and neonatal outcomes of preterm infants born in the USA who were exposed in-utero to drugs of substance use. METHODS Retrospective cohort study of preterm live born (<37 weeks gestation) exposed in-utero to opioids, hallucinogens, or cocaine in the Healthcare Cost and Utilization Project database from 2002 to 2017. Neonatal outcomes were identified using international classification of diseases 9&10 codes. RESULTS Of the 54,469,720 live-born infants, 7.7% (4,194,816) were preterm, and 58 679 (1.4%) were exposed in-utero to maternal opioids/hallucinogens (n = 39,335) or cocaine (n = 19,344). There was a trend for increased exposure to opioids/hallucinogens (Z score = 76.14, p < 0.001) during the study period. Exposed preterm infants had significantly more neurological anomalies, intra-ventricular hemorrhage and periventricular leukomalacia (p < 0.001). CONCLUSIONS There was a trend for increased in-utero exposure to opioids and hallucinogens in the preterm infants in the USA. Exposed preterm infants had more neurological morbidities.
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Affiliation(s)
- Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hasan Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA
| | - Rachana Sripathi
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Vanishree Nandakumar
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Park TJ, Hansen R, Gillard P, Shah D, Ferguson WG, Piccini J, Romano MA, Devine B. Healthcare resource utilization and costs for patients with postoperative atrial fibrillation in the United States. J Med Econ 2023; 26:1417-1423. [PMID: 37801391 DOI: 10.1080/13696998.2023.2267390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery. POAF is associated with increased hospitalization costs, but its long-term economic burden is not well defined. OBJECTIVE To assess 30-day and 1-year incremental healthcare resource utilization (HRU) and costs associated with POAF in the United States (US). METHODS This retrospective cohort study used claims data from the IBM Watson MarketScan database. A cohort of US adults aged 55--90 years who underwent open-heart surgery between 1 January 2017 and 31 December 2018 was used to compare patients who experienced POAF versus patients who did not (controls). The outcomes of interest were incremental HRU and costs, which were assessed during the index hospitalization and 30-day and 1-year postdischarge time periods. Inverse probability weighting was used to adjust for differences in baseline characteristics. RESULTS A total of 8,020 patients met the study inclusion criteria with 5,765 patients in the control cohort (mean age, 63.4 years) and 2,255 patients in the POAF cohort (mean age, 65.8 years). After adjustment, patients with POAF had an index hospitalization that was 1.9 days longer (99% CI, 1.3-2.4 days; p < 0.001) and cost $13,919 more (99% CI, $2,828-$25,011; p < 0.001) than for patients without POAF. POAF patients also had significantly higher HRU at 30 days and 1-year postdischarge with incremental costs of $4,649 (99% CI, $1,479-$7,819; p < 0.001) and $10,671 (99% CI, $2,407-$18,935; p < 0.001), respectively. CONCLUSION POAF following open-heart surgery poses a significant economic burden up to 1 year postdischarge.
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Affiliation(s)
- Tae Jin Park
- Allergan, an AbbVie Company, Irvine, CA, USA
- University of Washington, Seattle, WA, USA
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Chen F, Chen X, Gu P, Sang X, Wu R, Tian M, Ye Y, Long C, Bishwajit G, Ji L, Feng D, Yang L, Tang S. The economic burden of malaria inpatients and its determinants during China's elimination stage. Front Public Health 2022; 10:994529. [PMID: 36388376 PMCID: PMC9651145 DOI: 10.3389/fpubh.2022.994529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023] Open
Abstract
Background Malaria burden is still worrisome, while empirical evidence from malaria-eliminated countries including China may provide inspiration for the world. Objective This study aimed to investigate China's malaria hospitalization costs and explore its determinants. Methods Stratified multistage sampling across provincial, municipal, and county hospitals was conducted in 2017. All the malaria medical records were retrieved from 2014 to 2016 in 70 hospitals. Parametric and non-parametric methods were employed to estimate hospitalization costs, and the non-parametric bootstrap was used to compare hospitalization costs among sample areas and assessed the uncertainty of its differences. Quantile regressions were conducted to identify the determinants of hospitalization costs. Results The median hospitalization costs of 1633 malaria inpatients were 628 USD. Medication and laboratory tests accounted for over 70% of total expenditure. The median reimbursement rate was 41.87%, and this number was even lower in higher-level hospitals (<35%) and among the New Rural Cooperative Medical Scheme (<40%). Finally, health insurance type, hospital tier, clinical units, unknown fever, and comorbidity were the main determinants of hospitalization costs. Conclusion The disparity of health protection for malaria hospitalization between rural and urban areas was noteworthy. Equivocal diagnosis and comorbidity are contributors of high cost as well. A reasonable payment system and enhanced capacities to treat malaria in a cost-effective way are suggested to reassure malaria economic burden.
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Affiliation(s)
- Fangfei Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Peng Gu
- Division of Comprehensive, China Science and Technology Exchange Center, Beijing, China
| | - Xiaodong Sang
- Division of Comprehensive and Supervision, China Biotechnology Development Center, Beijing, China
| | - Ruijun Wu
- Division of Strategy and Policy, China Biotechnology Development Center, Beijing, China
| | - Miaomiao Tian
- Division of Public Rights Protection, Beijing Municipal Health Commission, Beijing, China
| | - Yisheng Ye
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chengxu Long
- Faculty of Social Science and Public Policy, King's College, London, United Kingdom
| | - Ghose Bishwajit
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Yang
- College of Public Administration, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Lei Yang
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,Shangfeng Tang
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13
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Broder MS, Chen E, Yan JT, Chang E, Tarbox MH, Larkin AA, White KK. National burden of achondroplasia: an analysis of the National Inpatient and Nationwide Ambulatory Surgery Samples. J Comp Eff Res 2022; 11:1135-1146. [PMID: 36039778 DOI: 10.2217/cer-2021-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To estimate the cost of US hospital admissions and outpatient surgeries associated with achondroplasia. Materials & methods: Using 2017 data from nationally representative databases, this study identifies hospital admissions and outpatient encounters with an achondroplasia diagnosis. Descriptive measures are reported. Results: There were 1985 achondroplasia admissions nationwide. The most frequent admissions were neonatal care (33.7%) in children and musculoskeletal (22.7%) in adults. Average hospital length of stay was 6.8 days, 2.2 days longer than the US mean. Total mean inpatient costs were US$19,959, $7789 greater than the US mean. In the outpatient setting, children 5-14 years accounted for 56.9% of procedures. Conclusion: Achondroplasia is a serious condition with a wide range of lifelong complications frequently requiring hospitalization and surgical intervention.
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Affiliation(s)
- Michael S Broder
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Er Chen
- BioMarin Pharmaceutical Inc., San Rafael, CA 94901, USA
| | - Jessie T Yan
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Marian H Tarbox
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
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Zhang X, Zhang L. The Impact of Instant Reimbursement of Cross-Regional Medical Services on Hospitalization Costs Incurred by the Floating Population-Evidence from China. Healthcare (Basel) 2022; 10:healthcare10061099. [PMID: 35742150 PMCID: PMC9223039 DOI: 10.3390/healthcare10061099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The medical cost reimbursement function of medical insurance can reduce the medical burden of individuals and thus improve their medical service utilization level. This study aimed to explore the impact of different cross-regional reimbursement types of medical insurance (instant reimbursement and manual reimbursement) on the hospitalization costs incurred by the floating population. Methods: The data used in this study was from the 2018 China Migrants Dynamic Survey (CMDS) conducted by the National Health Commission of China. The multiple linear regression model and Propensity Score Matching method (PSM) were used to analyze the impact of instant and manual reimbursement on hospitalization costs. Results: (1) Instant reimbursement and manual reimbursement could significantly reduce the floating population’s out-of-pocket proportion of hospitalization costs by 33.2% and 26.9%, respectively; (2) the average proportion and amounts of out-of-pocket hospital costs of instant reimbursement for the floating population were lower than those of manual reimbursement by 6.35% and 19.6%, respectively, and this impact would gradually increase as the flow distance expanded; (3) there was no significant impact of instant reimbursement on the total hospitalization costs relative to manual reimbursement. Conclusions: Our study suggests that instant reimbursement can effectively reduce the out-of-pocket medical burden of the floating population at the individual level, but it will not have an obvious impact on the total hospitalization costs at the social level.
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15
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Shen WT, Yu X, Zhong SB, Ge HR. Population Health Effects of Air Pollution: Fresh Evidence From China Health and Retirement Longitudinal Survey. Front Public Health 2022; 9:779552. [PMID: 35004584 PMCID: PMC8733201 DOI: 10.3389/fpubh.2021.779552] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
The effects of air pollution on population health are currently a hot topic. However, few studies have examined the physical and mental health effects of air pollution jointly in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this study explores how air pollution affects the physical and mental health of middle-aged and elderly residents. The empirical results highlight that air pollution can negatively affect both physical and mental health. In terms of physical health, those exposed to chronic shock are likely to suffer more adverse effects from air pollution than those exposed to acute shock. In terms of mental health, those exposed to depression suffer greater adverse effects than those exposed to episodic memory and mental cognition. Besides, heterogeneity analysis also shows that air pollution affects the mental and physical health of males more than females. Furthermore, the increase in air pollution is expected to result in huge hospitalization costs. Therefore, the Chinese government should formulate differentiated public health policies to reduce the effects of air pollution on the health of middle-aged and elderly residents.
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Affiliation(s)
- Wei-Teng Shen
- Business School, Zhejiang Wanli University, Ningbo, China
| | - Xuan Yu
- Business School, Ningbo University, Ningbo, China
| | - Shun-Bin Zhong
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Hao-Ran Ge
- Business School, Zhejiang Wanli University, Ningbo, China
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16
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Shirane S, Michihata N, Yoshiuchi K, Ariyoshi K, Iwase S, Morita K, Matsui H, Fushimi K, Yasunaga H. Evaluation of quality indicators near death in older adult cancer decedents in Japan: A nationwide retrospective cohort study. Jpn J Clin Oncol 2021; 51:1643-1648. [PMID: 34530454 DOI: 10.1093/jjco/hyab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES End-of-life cancer care is important; however, data on hospitalization and costs for older patients have been lacking. We aimed to examine quality indicators and costs for older patients in Japan. METHODS Using the Diagnosis Procedure Combination database, a national database of acute-care hospitals in Japan, we retrospectively collected data on cancer decedents aged ≥65 years. We evaluated the quality indicators (hospitalizations, length of stay in the hospital, emergency hospitalizations, emergency hospitalizations using an ambulance, intensive care unit [ICU] admissions, length of stay in the ICU, interval between last chemotherapy use and death, and chemotherapy within 14 days before death) and hospitalization costs at 30, 90 and 180 days before death. We compared the outcomes across age groups (65-74, 75-84 and ≥ 85 years). RESULTS Between January 2011 and March 2015, we identified 369 616 cancer decedents. From 180 to 30 days before death, there were increases in emergency hospitalizations, emergency hospitalizations using an ambulance, and the mean costs per hospital day. Overall, 16.7% of patients receiving chemotherapy last received this treatment on the day before death or the day of death. Costs decreased with increasing age. The group aged ≥85 years had the shortest hospital and ICU stays and the lowest multiple hospitalizations, ICU admissions, chemotherapy within 14 days before death, and costs. CONCLUSIONS Many older adult patients had emergency hospitalizations and received chemotherapy just prior to death, and there is room for improvement in appropriate end-of-life care. Oldest old patients consumed relatively few medical resources.
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Affiliation(s)
- Sachie Shirane
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Ariyoshi
- Department of Data Management, Japanese Organisation for Research and Treatment of Cancer Data Center, Tokyo, Japan
| | - Satoru Iwase
- Department of Emergency and Palliative Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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17
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Wojciak AS, Butcher B, Conrad A, Coohey C, Oral R, Peek-Asa C. Trends, Diagnoses, and Hospitalization Costs of Child Abuse and Neglect in the United States of America. Int J Environ Res Public Health 2021; 18:7585. [PMID: 34300039 PMCID: PMC8305453 DOI: 10.3390/ijerph18147585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/21/2023]
Abstract
We conducted a secondary analysis of the National Inpatient Sample (NIS) to examine child abuse and neglect hospitalization from 1998-2016. The NIS is the largest all-payer, inpatient care database in the United States and is maintained by the Health Care Utilization Project. Participants were youth 18 years and younger with discharged diagnoses of child abuse and neglect from hospitals. The rate of child abuse or neglect hospitalizations did not vary significantly over the study period (1998-2016), which on average was 6.9 per 100,000 children annually. Males (53.0%), infants (age < 1; 47.3%), and young children (age 1-3; 24.2%) comprised most of the child maltreatment cases. Physical abuse was the most frequent type of maltreatment leading to hospitalization. Government insurance was the most common payer source, accounting for 77.3% of all child maltreatment hospitalizations and costing 1.4 billion dollars from 2001-2016. Hospitalizations due to child abuse and neglect remain steady and are costly, averaging over $116 million per year. The burden on government sources suggests a high potential for return on investment in effective child abuse prevention strategies.
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Affiliation(s)
- Armeda Stevenson Wojciak
- Department of Family Social Science, College of Education and Human Development, University of Minnesota, St. Paul, MN 55108, USA
| | - Brandon Butcher
- Injury Prevention Research Center and Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.B.); (C.P.-A.)
| | - Aislinn Conrad
- School of Social Work, University of Iowa, Iowa City, IA 52242, USA; (A.C.); (C.C.)
| | - Carol Coohey
- School of Social Work, University of Iowa, Iowa City, IA 52242, USA; (A.C.); (C.C.)
| | - Resmiye Oral
- Children’s Hospital at Dartmouth, Geisel School of Pediatrics, Dartmouth College, Hanover, NH 03756, USA;
| | - Corinne Peek-Asa
- Injury Prevention Research Center and Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.B.); (C.P.-A.)
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18
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Dai P, Chang W, Xin Z, Cheng H, Ouyang W, Luo A. Retrospective Study on the Influencing Factors and Prediction of Hospitalization Expenses for Chronic Renal Failure in China Based on Random Forest and LASSO Regression. Front Public Health 2021; 9:678276. [PMID: 34211956 PMCID: PMC8239170 DOI: 10.3389/fpubh.2021.678276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: With the improvement in people's living standards, the incidence of chronic renal failure (CRF) is increasing annually. The increase in the number of patients with CRF has significantly increased pressure on China's medical budget. Predicting hospitalization expenses for CRF can provide guidance for effective allocation and control of medical costs. The purpose of this study was to use the random forest (RF) method and least absolute shrinkage and selection operator (LASSO) regression to predict personal hospitalization expenses of hospitalized patients with CRF and to evaluate related influencing factors. Methods: The data set was collected from the first page of data of the medical records of three tertiary first-class hospitals for the whole year of 2016. Factors influencing hospitalization expenses for CRF were analyzed. Random forest and least absolute shrinkage and selection operator regression models were used to establish a prediction model for the hospitalization expenses of patients with CRF, and comparisons and evaluations were carried out. Results: For CRF inpatients, statistically significant differences in hospitalization expenses were found for major procedures, medical payment method, hospitalization frequency, length of stay, number of other diagnoses, and number of procedures. The R2 of LASSO regression model and RF regression model are 0.6992 and 0.7946, respectively. The mean absolute error (MAE) and root mean square error (RMSE) of the LASSO regression model were 0.0268 and 0.043, respectively, and the MAE and RMSE of the RF prediction model were 0.0171 and 0.0355, respectively. In the RF model, and the weight of length of stay was the highest (0.730). Conclusions: The hospitalization expenses of patients with CRF are most affected by length of stay. The RF prediction model is superior to the LASSO regression model and can be used to predict the hospitalization expenses of patients with CRF. Health administration departments may consider formulating accurate individualized hospitalization expense reimbursement mechanisms accordingly.
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Affiliation(s)
- Pingping Dai
- Key Laboratory of Medical Information Research, Third Xiangya Hospital, Central South University, Changsha, China.,Department of Medical Information, School of Life Science, Central South University, Changsha, China
| | - Weifu Chang
- Key Laboratory of Medical Information Research, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zirui Xin
- Key Laboratory of Medical Information Research, Third Xiangya Hospital, Central South University, Changsha, China.,Department of Medical Information, School of Life Science, Central South University, Changsha, China
| | - Haiwei Cheng
- Department of Sociology, Central South University, Changsha, China
| | - Wei Ouyang
- Key Laboratory of Medical Information Research, Third Xiangya Hospital, Central South University, Changsha, China.,Department of Medical Information, School of Life Science, Central South University, Changsha, China
| | - Aijing Luo
- Second Xiangya Hospital, Central South University, Changsha, China
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19
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Dong M, Yang Z, Chen Y, Sun J, Ma W, Cheng S, Sun X, Xiao J, He G, Hu J, Wang J, Chen G, Zhou H, Yuan L, Li J, Li X, Xu H, Wang R, Chen D, Fang M, Liu T. Hospitalization Costs of COVID-19 Cases and Their Associated Factors in Guangdong, China: A Cross-Sectional Study. Front Med (Lausanne) 2021; 8:655231. [PMID: 34179041 PMCID: PMC8226137 DOI: 10.3389/fmed.2021.655231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The ongoing COVID-19 pandemic has brought significant challenges to health system and consumed a lot of health resources. However, evidence on the hospitalization costs and their associated factors in COVID-19 cases is scarce. Objectives: To describe the total and components of hospitalization costs of COVID-19 cases, and investigate the associated factors of costs. Methods: We included 876 confirmed COVID-19 cases admitted to 33 designated hospitals from January 15th to April 27th, 2020 in Guangdong, China, and collected their demographic and clinical information. A multiple linear regression model was performed to estimate the associations of hospitalization costs with potential associated factors. Results: The median of total hospitalization costs of COVID-19 cases was $2,869.4 (IQR: $3,916.8). We found higher total costs in male (% difference: 29.7, 95% CI: 15.5, 45.6) than in female cases, in older cases than in younger ones, in severe cases (% difference: 344.8, 95% CI: 222.5, 513.6) than in mild ones, in cases with clinical aggravation than those without, in cases with clinical symptoms (% difference: 47.7, 95% CI: 26.2, 72.9) than those without, and in cases with comorbidities (% difference: 21.1%, 21.1, 95% CI: 4.4, 40.6) than those without. We also found lower non-pharmacologic therapy costs in cases treated with traditional Chinese medicine (TCM) therapy (% difference: -47.4, 95% CI: -64.5 to -22.0) than cases without. Conclusion: The hospitalization costs of COVID-19 cases in Guangdong were comparable to the national level. Factors associated with higher hospitalization costs included sex, older age, clinical severity and aggravation, clinical symptoms and comorbidities at admission. TCM therapy was found to be associated with lower costs for some non-pharmacologic therapies.
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Affiliation(s)
- Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Shouzhen Cheng
- Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jiaqi Wang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Guimin Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - He Zhou
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jiali Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xuan Li
- School of Exercise Science and Health, Guangxi College of Physical Education, Nanning, China
| | - Hui Xu
- Department of Intensive Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Intensive Care Medicine, Guangdong Provincial People's Hospital-Nanhai Hospital, Foshan, China
| | - Ruijie Wang
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Dengzhou Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ming Fang
- Department of Intensive Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Intensive Care Medicine, Guangdong Provincial People's Hospital-Nanhai Hospital, Foshan, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- School of Medicine, Jinan University, Guangzhou, China
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20
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Wang C, Huang C, Zhu X. Composition and changes in breast cancer patients' diagnosis and treatment expenses under the influence of medical insurance policy reform-A study on 3 950 patients in Guangxi Medical University Cancer Hospital. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:521-528. [PMID: 34148889 PMCID: PMC10930216 DOI: 10.11817/j.issn.1672-7347.2021.200525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To understand the influence of medical insurance policy reforms in Guangxi on the hospitalization expenses of breast cancer patients by analyzing the composition and changing trend in breast cancer diagnosis and treatment expenses in the Guangxi Medical University Cancer Hospital, and to provide the evidence for the improvement of medical insurance policy reform. METHODS A total of 3 950 breast cancer patients were collected from 2014 to 2017 and analyzed. Kruskal-Wallis test and multiple linear regression model were used to discuss the breast cancer related epidemiology and analyze the composition of hospitalization expenses and its influential factors. RESULTS The median hospitalization cost of breast cancer patients in our hospital from 2014 to 2017 was 29 266.94 Chinese Yuan. Single factor analysis showed that the impact of year, hospitalization days, age, payment method, tumor stage, and treatment method on hospitalization cost was significant (all P<0.01). Multiple linear regression analysis showed that the power of influential factors of hospitalization costs arranged descending from 2014 to 2017 as follows: hospitalization days, treatment methods, payment method, tumor staging, and age. CONCLUSIONS Reasonably controlling hospitalization days and actively promoting the integration of urban and rural medical insurance can effectively reduce the economic burden for breast cancer patients.
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Affiliation(s)
- Chengbang Wang
- Department of Breast, Guangxi Medical University Cancer Hospital, Nanning 530021.
| | - Chan Huang
- Department of Breast, Guangxi Medical University Cancer Hospital, Nanning 530021
| | - Xiao Zhu
- Department of Health Insurance and Health Care, Guangxi Medical University Cancer Hospital, Nanning 530021, China.
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Abstract
Background To evaluate the clinical characteristics and indications for surgery for
bezoar-induced small bowel obstruction (BI-SBO). Methods Forty patients with BI-SBO were treated at our hospital from January 2017 to
December 2019, and these patients’ clinical and computed tomography (CT)
data were analyzed. Results Twenty-seven and 13 BI-SBO patients constituted the non-ST group and ST
group, respectively. The clinical manifestations of BI-SBO in both groups
were abdominal pain, nausea, vomiting, and lack of defecation. Comparing the
non-ST vs ST groups, respectively: mean age (years): 63.15 ± 16.15 vs
60.38 ± 12.47; duration of symptoms (hours): 55.11 ± 44.08 vs 59.33 ± 72.90;
mean bezoar length (cm): 5.31 ± 0.74 vs 3.72 ± 0.53; mean bezoar width (cm):
3.74 ± 0.48 vs 2.9 ± 0.64; bezoar CT maximum Hounsfield units (HU):
97.23 ± 12.36 vs 21.11 ± 7.27; total hospital stay (days): 5.56 ± 4.23 vs
7.12 ± 6.12 (mean: 8.62 ± 2.81); and total hospitalization costs (RMB):
6378.02 ± 3015.68 vs 8213.71 ± 5564.29. Mean operation time was 85.00 ± 8.90
minutes, and mean operation blood loss was 32.31 ± 19.64 mL. Bezoars were
located 60 to 160 cm from the ileocecal junction. Univariate analysis
demonstrated that bezoar length and width and maximum CT value were
significant risk factors for surgery. Conclusion Large bezoar size and high CT values may be indications for surgery. Surgery
is necessary and effective when nonsurgical treatment is ineffective.
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Affiliation(s)
- Shuai Wang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Xiaohui Yang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yixiong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yulian Wu
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
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Ma Y, Liu D, Ji Y, Wei X, Pan D, Xu F, Di Q, Chen X, Luo F, Zhang J, Ou G, Zhang Y, Li K, Zhang D, Wang W, Xu J, Li J, Zhu D, Tian F, Fan M. Clinical features related to hospital expenses for non-cystic fibrosis bronchiectasis in China. J Int Med Res 2021; 48:300060520931616. [PMID: 32567421 PMCID: PMC7309388 DOI: 10.1177/0300060520932116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective Bronchiectasis is a common chronic airway disease. We investigated the economic burden and associated factors of bronchiectasis in China. Methods In this multicenter retrospective cohort study, we reviewed medical records of patients admitted to 18 tertiary hospitals during 2010 to 2014 with a bronchiectasis-related diagnosis. Results A total 5469 patients with bronchiectasis were admitted, accounting for 3.13% ± 1.80% of all discharged patients with any diagnosis during the same period; 13 patients died upon discharge. The median hospitalization cost was RMB 8421.52 (RMB 5849.88–12,294.47). Risk factors associated with hospitalization costs included age at admission (>70 vs. <40 years, odds ratio (OR) = 1.221, 95% confidence interval (CI) = 1.082–1.379; >80 vs. <40 years, OR = 1.251, 95% CI = 1.089–1.438), smoking (≤15 packs/year vs. non-smokers, OR = 1.125, 95% CI = 1.006–1.271; >15 packs/year vs. non-smokers, OR = 1.127, 95% CI = 1.062–1.228), length of hospitalization (OR = 1.05, 95% CI = 1.046–1.054), combination antibiotic treatment (OR = 1.089, 95% CI = 1.033–1.148), cough (OR = 0.851, 95% CI = 0.751–0.965), dyspnea (OR = 0.93, 95% CI = 0.878–0.984), chronic obstructive pulmonary disease (OR = 0.935, 95% CI = 0.878–0.996), respiratory failure (OR = 0.923, 95% CI = 0.862–0.989), cor pulmonale (OR = 0.919, 95% CI = 0.859–0.982), and death (OR = 1.816, 95% CI = 1.113–2.838). Conclusions Age, smoking status, symptoms, and respiratory comorbidities were associated with hospitalization costs of bronchiectasis.
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Affiliation(s)
- Yanliang Ma
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Daishun Liu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Zunyi City, Zunyi City, Guizhou Province, China
| | - Yingqun Ji
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xuemei Wei
- Department of Respiratory and Critical Care Medicine, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Dianzhu Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Fei Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingguo Di
- Department of Pulmonary and Critical Care Medicine Ward 1, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xiaoju Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiujin Zhang
- Department of Respiratory and Critical Care Medicine, Guangxi Yulin First People's Hospital, Yulin, Guangxi, China
| | - Guiying Ou
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China.,Department of Respiratory Medicine, Central Hospital in Zhungeer Banner, Muqi Road, Zhungeer Banner, Erdos, Inner Mongolia, China
| | - Yan Zhang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China.,Department of Respiratory Medicine, People's Hospital of Nanpi County, Nanpi, Hebei, China
| | - Kaishu Li
- Department of Respiratory and Critical Care Medicine, Binzhou People's Hospital, Binzhou, Shandong, China
| | - Dong Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Wanping Wang
- Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital of Shanxi, Changzhi, Shanxi, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jianying Li
- Department of Respiratory Medicine, Xi'an Central Hospital Affiliated to Medical College of Xi'an JiaoTong University, Xian, Shanxi, China
| | - Dan Zhu
- Department of Respiratory Medicine, Jinhua Central Hospital of Zhejiang, Jinhua, Zhejiang, China
| | - Feng Tian
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China
| | - Manqi Fan
- Department of Respiratory Medicine, Kunming General Hospital of Chengdu Military Command, Kunming, Yunnan, China All authors contributed equally to this paper
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Xu Y, Liu A, Chen L, Huang H, Gao Y, Zhang C, Xu Y, Huang D, Xu D, Zhang M. Enhanced recovery after surgery (ERAS) pathway optimizes outcomes and costs for minimally invasive radical prostatectomy. J Int Med Res 2021; 48:300060520920072. [PMID: 32485118 PMCID: PMC7273798 DOI: 10.1177/0300060520920072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the impact of an enhanced recovery after surgery (ERAS) pathway
on patients undergoing minimally invasive radical prostatectomy at a single
institute. Methods In this retrospective study, 301 patients who underwent laparoscopic or
robot-assisted laparoscopic radical prostatectomy from May 2014 to September
2018 were consecutively recruited. Before April 2017, the patients were
treated with conventional care; all patients were treated with the ERAS
pathway thereafter. The primary outcome was the postoperative length of
hospital stay (LOS). The secondary outcomes were hospitalization costs and
postoperative complications. Results In total, 138 patients were treated with the ERAS pathway, and the remaining
patients underwent conventional care. The postoperative LOS was
significantly shorter in the ERAS group than in the conventional group
(median, 6 vs. 8 days). The hospitalization costs were also significantly
lower in the ERAS group ($4086 vs. $5530). Ten (6.1%) patients in the ERAS
group and 17 (12.3%) patients in the conventional group developed
postoperative complications. The multivariable analysis showed that ERAS
care was a significant independent predictive factor for a shortened LOS and
reduced hospitalization costs. Conclusions The ERAS pathway was associated with a shortened LOS and reduced
hospitalization costs for patients undergoing minimally invasive radical
prostatectomy.
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Affiliation(s)
- Ying Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ao Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Gao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanjie Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Desai NR, Alvarez PJ, Golestaneh L, Woods SD, Coca SG, Rowan CG. Healthcare utilization and expenditures associated with hyperkalemia management: a retrospective study of Medicare Advantage patients. J Med Econ 2021; 24:1025-1036. [PMID: 34357841 DOI: 10.1080/13696998.2021.1965389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS This study aimed to estimate the association of patiromer exposure vs. no potassium (K+) binder (NoKb) exposure with healthcare utilization and expenditures among a cohort of Medicare Advantage patients with hyperkalemia (HK). METHODS Using Optum's Clinformatics Data Mart (study period 2016-2019), the authors assessed propensity score-matched patients (1:1) with a serum K+ concentration ≥5.0 mmol/L and an HK diagnosis that were exposed to patiromer or NoKb on baseline characteristics. The following outcomes were compared: (1) inpatient/emergency department (ED) encounters, (2) inpatient costs greater than or equal to mean Medicare Advantage inpatient cost (i.e. $14,900), and (3) the relative healthcare spending rate. Logistic regression and zero-inflated negative binomial regression were used to analyze the outcomes. RESULTS The study cohort included 1,539 patiromer and NoKb matched pairs. Baseline characteristics were (patiromer/NoKb): age 74/75 years; female 42/40%; serum K+ 5.6/5.6 mmol/L; eGFR rate 36/36 mL/min/1.73 m2; low-income subsidy 42/41%, chronic kidney disease 96/96%; end-stage renal disease 12/12%; and congestive heart failure 37/36%. A total of 253 matched pairs (506 patients) remained uncensored and were analyzed at 6 months. Inpatient/ED encounters were observed for 25% (patiromer) and 37% (NoKb) (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.38-0.89). The relative odds of having inpatient costs ≥$14,900 were ∼50% less for patients exposed to patiromer vs. NoKb (OR [95% CI]: 0.47 [0.25-0.89]). The relative total healthcare spending rate (including inpatient, outpatient, ED, and pharmacy costs) was 19% less for patients exposed to patiromer vs. NoKb (spending rate ratio [95% CI]: 0.81 [0.67-0.98]). CONCLUSION AND LIMITATIONS Among Medicare Advantage patients with HK, patiromer exposure (vs. NoKb) was associated with statistically significant reductions in the proportion with inpatient/ED encounters, inpatient costs ≥$14,900, and lower total healthcare spending. Further research, with larger sample size, is warranted to fully validate these findings.
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Affiliation(s)
- Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale University, New Haven, CT, USA
| | | | - Ladan Golestaneh
- Renal Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kohli M, Charilaou P, Rousseau CP, Menezes R, Sanon M. Health care utilization in geriatric patients admitted with alcohol withdrawal from 2005 to 2014. Am J Drug Alcohol Abuse 2020; 46:478-484. [PMID: 34780316 DOI: 10.1080/00952990.2020.1725539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Alcohol-related and alcohol withdrawal (AW) hospitalizations are routinely underestimated in the geriatric population and can have a significant impact on healthcare resource utilization. OBJECTIVES To examine various patient-characteristics, hospitalization-outcomes, and prevalence of AW related-hospitalizations. METHODS In this retrospective study, we examined the objectives mentioned above over a 10-year period (2005 to 2014) using the Nationwide Inpatient Sample (NIS) in adults aged 65 years or older. National estimates of trends for AW prevalence and matched-regression analyses were conducted. RESULTS Increased prevalence of hospitalizations for AW was observed (148-cases-per-100,000-discharges in 2005 to 283-cases-per-100,000-discharges in 2014). Of the overall nationwide hospital admissions in patients aged 65 and older (128,111,787), 0.21% (264,786) with documented AW were identified. Of these, those of age 65-74 years accounted for 72.7% of admissions with the highest prevalence amongst males (males accounted for 74%, women 26%) and individuals of Caucasian ethnicity (79.9%).On comparing AW to Non-AW related-hospitalizations, patients admitted with AW had a higher median length of stay (five vs. four days), more significant functional decline with only 44.2% discharges being discharged home (vs. 47.2%) and 34.4% AW related discharges requiring discharge to skilled nursing facilities (vs. 28.5%). Higher hospitalization costs totaling $4,000 more on bivariate analysis were observed for the AW group. CONCLUSIONS The prevalence of admissions with AW has increased in the inpatient geriatric population, contributing to increased length of stay, higher hospitalization costs, and greater functional decline. Recognition of these findings and the development of programs supporting older adults with alcohol use disorder may improve patient outcomes.
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Affiliation(s)
- Maanit Kohli
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paris Charilaou
- Division of Gastroenterology & Hepatology, Saint Peter's University Hospital/Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Carl-Philippe Rousseau
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Martine Sanon
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
OBJECTIVE Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. METHODS A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. RESULTS The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. CONCLUSIONS Our findings clearly indicate that a vertigo-dizziness management program based on patients' risk factors may achieve to reduce hospitalizations and cost of hospital care as well.
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Affiliation(s)
- Şule Özdemir
- Department of Public Health, 37139University of 19 Mayıs, Samsun, Turkey
| | - Doğukan Özdemir
- Department of Otorhinolaryngology, University of Health Sciences, Samsun, Turkey
| | - Özlem Terzi
- Department of Public Health, 37139University of 19 Mayıs, Samsun, Turkey
| | - Dursun Mehmet Mehel
- Department of Otorhinolaryngology, University of Health Sciences, Samsun, Turkey
| | - Abdulkadir Özgür
- Department of Otorhinolaryngology, University of Health Sciences, Samsun, Turkey
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Xiao X, Chang R, Gao Y. Clinical Outcomes And Cost-Effectiveness Of Different Staplers For Lung Lobectomy With Video-Assisted Thoracic Surgery. Cancer Manag Res 2020; 11:9599-9607. [PMID: 32009815 PMCID: PMC6859165 DOI: 10.2147/cmar.s230926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to compare intra-operative adverse events (AE), post-operative outcomes, and costs of three different types of Echelon staplers (manual activated SC45A and electrical power-activated PSE45A & PSEE60A) used during video-assisted thoracic surgery (VATS) for lung lobectomy. Patients and methods We carried out a retrospective chart review of patients undergoing VATS lobectomies using one of three staplers (SC45A, PSE45A, or PSEE60A) during a 2-year period at our institution. We compared intra-operative AEs, post-operative outcomes (drainage volume, chest tube duration, prolonged air leaks [PALs]), endoscopic product costs [ECs], and hospitalization costs [HCs]) amongst the three stapler groups. Results In all 204 peripheral lung cancer patients were included in the study (95 in the SC45A group, 72 in the PSE45A group, and 37 in the PSEE60A group). We observed intra-operative AEs in 6 patients of the SC45A group, in 4 of the PSE45A group, and in 1 of the PSEE60A group (P>0.05). Drainage volumes among the three groups were similar. The mean chest tube duration was shorter]st in the PSE45A group followed by those in the PSEE60A and SC45A groups (P<0.05). PALs were lowest in the PSE45A group and highest in the SC45A group (P<0.05). The mean EC in the PSEE60A group was significantly higher than those in the other two groups (P<0.05). We found no statistically significant differences in terms of HCs among groups. Conclusion The three endoscopic staplers had similar incidences of intra-operative AEs when used for lobectomy with VATS. Use of the PSE45A stapler was associated with the shortest chest tube duration and least PALs, while use of the PSEE60A resulted in the highest EC rate.
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Affiliation(s)
- Xiaoxiong Xiao
- Thoracic Surgery Department, Xiangya Hospital Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Ruimin Chang
- Thoracic Surgery Department, Xiangya Hospital Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Yang Gao
- Thoracic Surgery Department, Xiangya Hospital Central South University, Changsha 410008, Hunan, People's Republic of China
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Wang Q, Zhang S, Wang Y, Zhang X, Zhang Y. Factors Associated With Hospitalization Costs of Coronary Heart Disease in Township Hospitals in Rural China. Inquiry 2019; 56:46958019886958. [PMID: 31701787 PMCID: PMC6843734 DOI: 10.1177/0046958019886958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.
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Affiliation(s)
- Qun Wang
- Dalian University of Technology, China
| | | | - Yaling Wang
- Affiliated Fuyang Hospital of Anhui Medical University, China
| | - Xichun Zhang
- Administration Office of New Rural Cooperative Medical System in Liaoning, Shenyang, China
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Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States and costs approximately $50 billion in annual healthcare costs. Certain interventions such as COPD inpatient education programs have demonstrated effectiveness in reducing healthcare utilization and reducing healthcare associated costs. Purpose: To assess the effectiveness of chronic obstructive pulmonary disease (COPD) inpatient education using existing respiratory therapy staff in an academic health system. Methodology/Approach: This retrospective observational study employed a matched case-control design. Inpatients admitted with a COPD related condition in this study received self-management interventions from Registered Respiratory Therapists (RTs). The sample includes retrospective administrative and medical record data on 84 inpatients with a diagnosis of COPD admitted in 2016 through 2017. Patients received self-management interventions at the bedside by trained RTs while admitted to acute care areas, progressive care units and intermediate care units. Effectiveness of inpatient education was compared before and after the interventions. Hospitalization costs and length of stay (LOS) are the primary outcome measures. Results: Statistical analyses revealed that inpatient COPD education appears to reduce hospital length of stay and associated costs. Post hoc regression analyses revealed that age, gender, marital status, and number of visits were significantly associated with LOS; whereas, smoking, LOS, and number of visits were significantly associated with hospitalization costs. Practice Implications: COPD patient education may be an effective strategy at reducing hospital costs and healthcare utilization overall. Empowering patients to take responsibility for their own health outcomes by improving self-efficacy has proven to demonstrate value.
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Affiliation(s)
- Hengameh M Hosseini
- Department of Health Administration and Human Resources, University of Scranton , Scranton , Pennsylvania , USA
| | - Dinesh R Pai
- Department of Supply Chain Management, School of Business Administration, Penn State Harrisburg , Middletown , Pennsylvania , USA
| | - Daniel R Ofak
- Department of Health Administration, School of Public Affairs, Penn State Harrisburg , Middletown , Pennsylvania , USA
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Guo Y, Sun J, Hu S, Nicholas S, Wang J. Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China. Int J Environ Res Public Health 2019; 16:ijerph16193526. [PMID: 31547207 PMCID: PMC6801864 DOI: 10.3390/ijerph16193526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
Abstract
Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.
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Affiliation(s)
- Yawei Guo
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jian 250014, China.
| | - Simeng Hu
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Stephen Nicholas
- School of Management and School of Economics, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China.
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2038, Australia.
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun, Guangzhou, Guangdong 510420, China.
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China.
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, Hubei Province 430072, China.
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Abstract
BACKGROUND The objective of this study was to explore the influence factors of hospitalization costs of treating colorectal cancer in China. And the study provides new estimates on hospitalization costs and length of hospital stay for patients with colorectal cancer in China. METHODS Data for inpatient hospitalization associated with colorectal cancer were obtained from a 3-tier hospital in Guangdong Province and were analyzed post hoc. We conducted descriptive statistical methods, Wilcoxon rank-sum tests (for 2 groups) and the Kruskal-Wallis test (for more than 2 groups) to analyze the hospitalization costs of treating colorectal cancer. RESULTS The analysis included 8021 patients (female: 40.54%; mean age; 61.80 ± 13.28 years; male: 59.46%; mean age: 61.80 ± 13.28 years). The overall mean length of hospital stay was 11.35 days. Over the 5 years, the mean length of hospital stay showed a small decrease from 12.22 days in 2012 to 10.69 days in 2016, while per-day costs showed a trend of increase between 2012 and 2015 (increase from < 1190.94 to < 1382.50). The mean length of hospital stay was statistically significant difference was found for sexes (P = .039) and insurance status (P < .001). The mean hospitalization costs were < 16,279.58. Mean hospitalization costs were different among the UEBMI, the URBMI and the Unspecified (< 17,114.58, < 15,555.05, and < 17,735.30, respectively; P < .001). CONCLUSION The study showed that hospitalization costs increase were associated with a small decreasing length of hospital stay and increasing per-day hospitalization costs. Moreover, the proportion of the hospitalization costs reimbursed by insurances increased. For inpatients with UEBMI, it possibly lead to over treatment and the medical expense rise which result in medical resources waste and significant society costs. The rising hospitalization costs may lead to a remarkably increased financial burden in the future in China.
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Affiliation(s)
| | - Li-Zhong Liang
- Medical Insurance Office, Affiliated Hospital of Guangdong Medical University, Zhanjiang
| | - Zhong-Fang Zhang
- School of Public Finance and Public Administration, Jiangxi University of Finance and Economics, Nanchang
| | | | - Zhen-Yi Huang
- Department of finance, Central Hospital of Guangdong Agriculture Reclamation, Zhanjiang, China
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Klein EY, Jiang W, Mojica N, Tseng KK, McNeill R, Cosgrove SE, Perl TM. National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010-2014. Clin Infect Dis 2019; 68:22-28. [PMID: 29762662 PMCID: PMC6293004 DOI: 10.1093/cid/ciy399] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been associated with worse patient outcomes and higher costs of care than methicillin-susceptible (MSSA) infections. However, since prior studies found these differences, the healthcare landscape has changed, including widespread dissemination of community-associated strains of MRSA. We sought to provide updated estimates of the excess costs of MRSA infections. Methods We conducted a retrospective analysis using data from the National Inpatient Sample from the Agency for Healthcare Research and Quality for the years 2010-2014. We calculated costs for hospitalizations, including MRSA- and MSSA-related septicemia and pneumonia infections, as well as MRSA- and MSSA-related infections from conditions classified elsewhere and of an unspecified site ("other infections"). Differences in the costs of hospitalization were estimated using propensity score-adjusted mortality outcomes for 2010-2014. Results In 2014, estimated costs were highest for pneumonia and sepsis-related hospitalizations. Propensity score-adjusted costs were significantly higher for MSSA-related pneumonia ($40725 vs $38561; P = .045) and other hospitalizations ($15578 vs $14792; P < .001) than for MRSA-related hospitalizations. Similar patterns were observed from 2010 to 2013, although crude cost differences between MSSA- and MRSA-related pneumonia hospitalizations rose from 25.8% in 2010 to 31.0% in 2014. Compared with MSSA-related hospitalizations, MRSA-related hospitalizations had a higher adjusted mortality rate. Conclusions Although MRSA infections had been previously associated with higher hospitalization costs, our results suggest that, in recent years, costs associated with MSSA-related infections have converged with and may surpass costs of similar MRSA-related hospitalizations.
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Affiliation(s)
- Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Wendi Jiang
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Nestor Mojica
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Katie K Tseng
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Ryan McNeill
- Reuters News Agency, New York
- City University of New York Graduate School of Journalism, New York
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas
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Li M, Wang F, Chen R, Liang Z, Zhou Y, Yang Y, Chen S, Ung COL, Hu H. Factors contributing to hospitalization costs for patients with COPD in China: a retrospective analysis of medical record data. Int J Chron Obstruct Pulmon Dis 2018; 13:3349-3357. [PMID: 30349238 PMCID: PMC6190824 DOI: 10.2147/copd.s175143] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Hospitalization brings considerable economic pressure on COPD patients in China. A clear understanding of hospitalization costs for patients with COPD is warranted to improve treatment strategies and to control costs. Currently, investigation on factors contributing to hospitalization costs for patients with COPD in China is limited. This study aimed to measure the hospitalization costs of COPD and to determine the contributing factors. Patients and methods Medical record data from the First Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2016 were used for a retrospective analysis. Patients who were hospitalized with a diagnosis of COPD were included. Patient characteristics, medical treatment, and hospitalization costs were analyzed by descriptive statistics and multivariable regression. Results Among the 1,943 patients included in this study, 87.85% patients were male; the mean (SD) age was 71.15 (9.79) years; 94.49% patients had comorbidities; and 82.30% patients had health insurance. Regarding medical treatment, the mean (SD) length of stay was 9.38 (7.65) days; 11.12% patients underwent surgery; 87.91% used antibiotics; and 4.53% underwent emergency treatment. For hospitalization costs, the mean (SD) of the total costs per COPD patient per admission was 24,372.75 (44,173.87) CNY (3,669.33 [6,650.38] USD), in which Western medicine fee was the biggest contributor (45.53%) followed by diagnosis fee (27.00%) and comprehensive medical fee (12.04%). Regression found that reimbursement (-0.032; 95% CI -0.046 to 0.007), length of stay (0.738; 95% CI 0.832-0.892), comorbidity (0.044; 95% CI 0.029-0.093), surgery (0.145; 95% CI 0.120-0.170), antibiotic use (0.086; 95% CI 0.060-0.107), and emergency treatment (0.121; 95% CI 0.147-0.219) were significantly (P<0.01) associated with total hospitalization costs. Conclusion To control hospitalization costs for COPD patients in China, the significance of comorbidity, length of stay, antibiotic use, surgery, and emergency treatment suggests the importance of controlling the COPD progression and following clinical guidelines for inpatients. Interventions such as examination of pulmonary function for early detection, quality control of medical treatment, and patient education warrant further investigation.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, ;
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou China
| | - Shengqi Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, ;
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, ;
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, ;
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Abstract
BACKGROUND This study sought to identify factors that impact the total health care costs associated with hospitalization of young Japanese children with respiratory syncytial virus (RSV). METHODS Children admitted between April 2014 and March 2015 with at least a confirmed diagnosis of RSV and 2 days of hospital stay were considered for inclusion. Data analyses of hospital claims were performed using a structural equation modeling approach. RESULTS A total of 6811 Japanese inpatients (<5 years old) diagnosed with RSV were included. The average length of stay was 7.5 days with a mean total health care cost of US Dollars (USD) $3344 per hospitalization. Intensive care unit hospitalizations were associated with greater costs (USD +$4951) compared to routine hospitalizations. The highest procedure-related cost drivers were blood transfusions (USD +$6402) and tube feedings (USD +$3512). CONCLUSION The economic burden of RSV-related infection hospitalizations in Japan is considerable. Efforts should be toward immunization and therapeutic treatment strategies that reduce severity, prevent, or reduce the duration of hospitalization.
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Affiliation(s)
- Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | - Hiroshi Kubo
- Research and Development Department, Janssen Pharmaceutical KK, Tokyo, Japan
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Wigg AJ, Chin JK, Muller KR, Ramachandran J, Woodman RJ, Kaambwa B. Cost-effectiveness of a chronic disease management model for cirrhosis: Analysis of a randomized controlled trial. J Gastroenterol Hepatol 2018; 33:1634-1640. [PMID: 29462834 DOI: 10.1111/jgh.14127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/26/2018] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS In this follow-up study to a randomized controlled trial of a chronic disease management (CDM) model in cirrhosis, our aim was to assess the relative cost-effectiveness of this model compared with usual care during the 12-month study period, using incremental costs per death avoided as the primary outcome. METHODS Mean differences in hospitalization costs, deaths avoided, and change in Chronic Liver Disease Questionnaire (CLDQ) total scores were presented with 95% non-parametric bootstrapped confidence intervals. Results were also presented using a cost-effectiveness plane (CEP) and cost-effectiveness acceptability curve. RESULTS The CDM intervention was more expensive, by 18 521 AUD per participant, but more effective (% of deaths at 12 months: 10% vs 15% and 0.67 units increase per patient in CLDQ total scores). The resultant incremental cost-effectiveness ratios were 370 425 AUD per death avoided (95% confidence interval: -14 564 AUD to 2 059 373 AUD) and 27 547 AUD per unit improvement in the CLDQ total score (95% CI: 7455 AUD to 143 874 AUD). The CEPs demonstrated some uncertainty around cost-effectiveness. The cost-effectiveness acceptability curves demonstrated that at willingness to pay values of 400 000 AUD per additional death avoided and 40 000 AUD per unit improvement in the CLDQ, there was at least a 70% probability of CDM being more cost-effective than usual care. At 24 months, CDM was much more effective (12% less deaths but now also cheaper by 985 AUD per patient). CONCLUSIONS The analysis of data from a randomized controlled trial suggests that the CDM intervention used is likely to be cost-effective, relative to usual care, due to fewer patient deaths.
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Affiliation(s)
- Alan J Wigg
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Jong K Chin
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Kate R Muller
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Jeyamani Ramachandran
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Richard J Woodman
- School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Bou-Maroun LM, Meta F, Hanba CJ, Campbell AD, Yanik GA. An analysis of inpatient pediatric sickle cell disease: Incidence, costs, and outcomes. Pediatr Blood Cancer 2018; 65. [PMID: 28801954 DOI: 10.1002/pbc.26758] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify characteristics of pediatric sickle cell disease (SCD) hospitalizations and to examine admission demographics and medical expenditures. METHODS Admissions with SCD were identified from the 2009 and 2012 releases of the Healthcare and Cost Utilization Project's Kids Inpatient Database. Disease-specific secondary diagnoses including acute chest syndrome (ACS), vaso-occlusive pain crisis (VOC), splenic sequestration, and stroke/transient ischemic attack were analyzed for patient and hospital demographics. Analytical endpoints included total healthcare expenditures and mortality. RESULTS We reviewed 75,234 inpatient hospitalizations with a diagnosis of SCD. Over $900,000,000 was spent annually in associated healthcare expenditure. The median length of hospitalization stay (LOS) for all admissions was 3 days (interquartile range [IQR] 2-5 days). VOC was the most frequent secondary diagnosis, recording 48,698 total hospitalizations and a median LOS of 3 days (IQR 2-6 days). Of the 8,490 hospitalizations with ACS, the infant population had a significantly higher mortality rate compared to other age groups (2% vs. 0.3%, P < 0.001). Cerebral vascular accidents incurred the second highest median hospitalization cost ($18,956), behind ACS ($22,631). A high proportion of Caucasian patients died during hospitalization for VOC (0.4% vs. 0.1%, P = 0.014) and ACS (4% vs. 0.2%, P < 0.001) when compared to non-Caucasians. CONCLUSION Inpatient hospitalizations for secondary manifestations of pediatric SCD were associated with significant healthcare expenditures. Patients with an increased statistical risk for death during hospitalization included Caucasians with SCD complications of ACS and VOC, and patients <1-year-old with ACS. Further research is needed to substantiate the associated clinical significance of these findings.
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Affiliation(s)
- Laura M Bou-Maroun
- Central Michigan University, College of Medicine, Mt. Pleasant, Michigan
| | - Fabien Meta
- Department of Hematology, Wayne State University School of Medicine, Detroit, Michigan
| | - Curtis J Hanba
- Department of Hematology, Wayne State University School of Medicine, Detroit, Michigan
| | - Andrew D Campbell
- Comprehensive Sickle Cell Program, University of Michigan Medical Center, Ann Arbor, Michigan
- Division of Pediatric Hematology Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Gregory A Yanik
- Division of Pediatric Hematology Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
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Riou-Comte N, Mione G, Humbertjean L, Brunner A, Vezain A, Lavandier K, Marchal S, Bracard S, Debouverie M, Richard S. Implementation and Evaluation of an Economic Model for Telestroke: Experience from Virtuall, France. Front Neurol 2017; 8:613. [PMID: 29209268 PMCID: PMC5701923 DOI: 10.3389/fneur.2017.00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/03/2017] [Indexed: 01/07/2023] Open
Abstract
Background Telestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall, France, which includes one expert center (hub) and six spokes. Methods The model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub. We performed a cost–benefit analysis for all patients included in Virtuall from January 2014 to December 2015 to assess the economic balance in each center. Results 321 patients were prospectively included in the study. Application of the economic model resulted in overall financial balance with funding of a dedicated medical service in the hub, and reduced costs directly related to telestroke by an average of 10% in the spokes. The conditions generating the highest costs for the spokes were: a patient returning from the hub for re-hospitalization (mean cost of $1,995/patient); management of patients treated by intravenous thrombolysis without transfer to the hub (mean cost of $2,075/patient). The most favorable financial condition for the spokes remained simple transfer of patients to the hub and no return (mean cost of $329/patient). Conclusion We describe an economic model which can be applied to any telestroke system to ensure the optimal balance between hub and spoke centers.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | | | | | | | | | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France.,Centre d'Investigation Clinique Plurithématique CIC-P 1433, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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Sasaki N, Kunisawa S, Ikai H, Imanaka Y. Differences between determinants of in-hospital mortality and hospitalisation costs for patients with acute heart failure: a nationwide observational study from Japan. BMJ Open 2017; 7:e013753. [PMID: 28336741 PMCID: PMC5372154 DOI: 10.1136/bmjopen-2016-013753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Although current case-mix classifications in prospective payment systems were developed to estimate patient resource usage, whether these classifications reflect clinical outcomes remains unknown. The efficient management of acute heart failure (AHF) with high mortality is becoming more important in many countries as its prevalence and associated costs are rapidly increasing. Here, we investigate the determinants of in-hospital mortality and hospitalisation costs to clarify the impact of severity factors on these outcomes in patients with AHF, and examine the level of agreement between the predicted values of mortality and costs. DESIGN Cross-sectional observational study. SETTING AND PARTICIPANTS A total of 19 926 patients with AHF from 261 acute care hospitals in Japan were analysed using administrative claims data. MAIN OUTCOME MEASURES Multivariable logistic regression analysis and linear regression analysis were performed to examine the determinants of in-hospital mortality and hospitalisation costs, respectively. The independent variables were grouped into patient condition on admission, postadmission procedures indicating disease severity (eg, intra-aortic balloon pumping) and other high-cost procedures (eg, single-photon emission CT). These groups of independent variables were cumulatively added to the models, and their effects on the models' abilities to predict the respective outcomes were examined. The level of agreement between the quartiles of predicted mortality and predicted costs was analysed using Cohen's κ coefficient. RESULTS In-hospital mortality was associated with patient's condition on admission and severity-indicating procedures (C-statistics 0.870), whereas hospitalisation costs were associated with severity-indicating procedures and high-cost procedures (R2 0.32). There were substantial differences in determinants between the outcomes. In addition, there was no consistent relationship observed (κ=0.016, p<0.0001) between the quartiles of in-hospital mortality and hospitalisation costs. CONCLUSIONS The determinants of mortality and costs for hospitalised patients with AHF were generally different. Our results indicate that the same case-mix classifications should not be used to predict both these outcomes.
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Affiliation(s)
- Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Ikai
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Opila T, George A, El-Ghanem M, Souayah N. Trends in Outcomes and Hospitalization Charges of Infant Botulism in the United States: A Comparative Analysis Between Kids' Inpatient Database and National Inpatient Sample. Pediatr Neurol 2017; 67:53-8. [PMID: 28041655 DOI: 10.1016/j.pediatrneurol.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 10/03/2016] [Accepted: 10/12/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND New therapeutic strategies, including immune globulin intravenous, have emerged in the past two decades for the management of botulism. However, impact on outcomes and hospitalization charges among infants (aged ≤1 year) with botulism in the United States is unknown. METHODS We analyzed the Kids' Inpatient Database (KID) and National Inpatient Sample (NIS) for in-hospital outcomes and charges for infant botulism cases from 1997 to 2009. Demographics, discharge status, mortality, length of stay, and hospitalization charges were reported from the two databases and compared. RESULTS Between 1997 and 2009, 504 infant hospitalizations were captured in KID', and 340 hospitalizations from NIS, for comparable years. A significant decrease was observed in mean length of stay for 'KID (P < 0.01); a similar decrease was observed for the NIS. The majority of patients were discharged to home. Despite an initial decrease after 1997, an increasing trend was observed for 'KID/NIS mean hospital charges from 2000 to 2009 (from $57,659/$56,309 to $143,171/$106,378; P < 0.001/P < 0.001). A linear increasing trend was evident when examining mean daily hospitalization charges for both databases. In conducting a subgroup analysis of the 'KID database, the youngest patients with infantile botulism (≤1.9 months) displayed the highest average number of procedures during their hospitalization (P < .001) and the highest rate of mechanical ventilation (P < .001), compared with their older counterparts. CONCLUSION Infant botulism cases have demonstrated a significant increase in hospitalization charges over the years despite reduced length of stay. Additionally, there were significantly higher daily adjusted hospital charges and an increased rate of routine discharges for immune globulin intravenous-treated patients. More controlled studies are needed to define the criteria for cost-effective use of intravenous immune globulin in the population with infant botulism.
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Heikkilä P, Forma L, Korppi M. High-flow oxygen therapy is more cost-effective for bronchiolitis than standard treatment-A decision-tree analysis. Pediatr Pulmonol 2016; 51:1393-1402. [PMID: 27148885 DOI: 10.1002/ppul.23467] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 04/15/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
We evaluated the cost-effectiveness of high-flow nasal cannula (HFNC) to provide additional oxygen for infants with bronchiolitis, compared to standard low-flow therapy. The cost-effectiveness was evaluated by decision analyses, using decision tree modeling, and was based on real costs from our recently published retrospective case-control study. The data on the effectiveness of HFNC treatment were collected from earlier published retrospective studies, using admission rates to pediatric intensive care units (PICU). The analyses in the study showed that the expected treatment costs of each episode of infant bronchiolitis varied between €1,312-2,644 ($1,786-3,600) in the HFNC group and €1,598-3,764 ($2,175-5,125) in the standard treatment group. The PICU admission rates and consequential costs were lower for HFNC than for standard treatment. HFNC treatment proved more cost-effective than standard treatment in all the baseline analyses and was also more cost-effective in the sensitivity analyses, except for in the worst-case scenario analysis. In conclusion, our modeling demonstrated that HFNC was strongly cost-effective for infant bronchiolitis, compared to standard treatment because it was both more effective and less expensive. Thus, if children hospitalized for bronchiolitis need oxygen, it should be delivered as HFNC treatment. Pediatr Pulmonol. 2016;51:1393-1402. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paula Heikkilä
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Leena Forma
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Matti Korppi
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
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Jinjuvadia C, Jinjuvadia R, Mandapakala C, Durairajan N, Liangpunsakul S, Soubani AO. Trends in Outcomes, Financial Burden, and Mortality for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in the United States from 2002 to 2010. COPD 2016; 14:72-79. [PMID: 27419254 DOI: 10.1080/15412555.2016.1199669] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We evaluated the temporal trends of hospitalizations from acute exacerbation of COPD and determined its outcome and financial impact using the National (Nationwide) Inpatient Sample (NIS) databases (2002-2010). Individuals aged ≥ 18 years were included. Subjects who were hospitalized with primary diagnosis of COPD exacerbation and those who were admitted for other causes but had underlying acute exacerbation of COPD (secondary diagnosis) were captured by International Classification of Diseases-Ninth Revision (ICD-9) codes. The hospital outcomes and length of stay were determined. Multivariate logistic regression was used to identify the independent predictors of inpatient mortality. Overall acute exacerbation of COPD-related hospitalizations accounted for nearly 3.31% of all hospitalizations in the year 2002. This did not change significantly to year 2010 (3.43%, p = 0.608). However, there was an increase in hospitalization with secondary diagnosis of COPD. Elderly white patients accounted for most of the hospitalizations. Medicare was the primary payer source for most of the hospitalizations (73-75%). There was a significant decrease in inpatient mortality from 4.8% in 2002 to 3.9% in 2010 (slope -0.096, p < 0.001). Similarly, there was a significant decrease in average length of stay from 6.4 days in 2002 to 6.0 days in 2010 (slope -0.042, p < 0.001). Despite this, the hospitalization cost was increased substantially from $22,187 in 2002 to $38,455 in 2010. However, financial burden has increased over the years.
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Affiliation(s)
- Chetna Jinjuvadia
- a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA
| | - Raxitkumar Jinjuvadia
- b Division of Gastroenterology and Hepatology, Department of Medicine, Henry Ford Health System , Detroit , Michigan , USA
| | - Chaitanya Mandapakala
- a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA
| | - Navin Durairajan
- c Department of Internal Medicine , Detroit Medical Center/Wayne State University , Detroit , Michigan , USA
| | - Suthat Liangpunsakul
- d Division of Gastroenterology and Hepatology, Department of Medicine, and Roudebush Veterans Administration Medical Center , Indianapolis , Indiana , USA
| | - Ayman O Soubani
- a Division of Pulmonology and Critical Care Medicine, Department of Medicine, Wayne State University , Detroit , Michigan , USA
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Yu TC, Zhou H. Evaluation of techniques for handling missing cost-to-charge ratios in the USA Nationwide Inpatient Sample: a simulation study. J Comp Eff Res 2015; 4:473-83. [PMID: 26387587 DOI: 10.2217/cer.15.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Evaluate performance of techniques used to handle missing cost-to-charge ratio (CCR) data in the USA Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. METHODS Four techniques to replace missing CCR data were evaluated: deleting discharges with missing CCRs (complete case analysis), reweighting as recommended by Healthcare Cost and Utilization Project, reweighting by adjustment cells and hot deck imputation by adjustment cells. Bias and root mean squared error of these techniques on hospital cost were evaluated in five disease cohorts. RESULTS & CONCLUSION Similar mean cost estimates would be obtained with any of the four techniques when the percentage of missing data is low (<10%). When total cost is the outcome of interest, a reweighting technique to avoid underestimation from dropping observations with missing data should be adopted.
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Affiliation(s)
- Tzy-Chyi Yu
- Outcomes Research Methods & Analytics, US Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA
| | - Huanxue Zhou
- KMK Consulting, Inc., 7, North Tower, 23 Headquarters Plaza, Morristown, NJ 07960, USA
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Wang H, Lin X, Zhang Z, Wang Q, Chen JM, Liu J, Yuan L. The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital. Asia Pac J Public Health 2015; 27:49S-54S. [PMID: 25700857 DOI: 10.1177/1010539515572220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to study the components, influencing factors, and their changing trend in a Chinese hospital, so as to reduce the economic burden of inpatients with type 2 diabetes. Data were collected from 7487 cases. There were 4368 inpatients with type 2 diabetes during 2002-2012 in a Chinese hospital. Multivariate linear regression analysis was performed to explore the influencing factors of hospitalization costs. The number of inpatients and their hospitalization costs had increasing trends in the study period. The medicine, test, and examination charges were the main sources of total costs. Longer hospital stays, older ages, and more times of hospitalization led to higher medical costs. Actions should be taken on all fronts to control the rapidly increasing trend of hospitalization costs and to reduce hospital stays and the number of times of hospitalization to reduce the economic burden of diabetic inpatients.
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Affiliation(s)
- Hao Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | - Xuan Lin
- WISCO General Hospital, Wuhan, China
| | - Zhi Zhang
- WISCO General Hospital, Wuhan, China
| | - Quan Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | | | - Jing Liu
- WISCO General Hospital, Wuhan, China
| | - Li Yuan
- WISCO General Hospital, Wuhan, China
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Gradman AH, Vekeman F, Eldar-Lissai A, Trahey A, Ong SH, Duh MS. Is addition of vasodilators to loop diuretics of value in the care of hospitalized acute heart failure patients? Real-world evidence from a retrospective analysis of a large United States hospital database. J Card Fail 2014; 20:853-63. [PMID: 25152497 DOI: 10.1016/j.cardfail.2014.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current guidelines recommend the use of intravenous (IV) vasodilators in addition to IV loop diuretics for the treatment of acute heart failure (AHF) patients without hypotension. The evidence basis for these recommendations is limited. METHODS AND RESULTS Hospital billing records for 82,808 AHF patients in the United States were analyzed. Patients receiving IV loop diuretics alone were paired with patients receiving IV loop diuretics + IV nitrates or IV nesiritide with the use of propensity score matching, excluding those with hypotension and/or evidence of cardiogenic shock, myocardial infarction, or acute coronary syndrome. Compared with paired patients receiving IV loop diuretics alone, in-hospital mortality was similar among IV loop diuretics + IV nitrates patients (n = 4,401; 1.9% vs 2.0%; P = .88) and marginally higher for IV loop diuretics + IV nesiritide patients (n = 2,254; 2.2% vs 3.1%; P = .05). Compared with paired IV loop diuretics patients, IV loop diuretics + IV nitrates or IV nesiritide had longer lengths of stay (+1.6 and +2.1 days; P < .01) and 57% higher costs (P < .01). CONCLUSIONS Among hospitalized AHF patients, the addition of IV vasodilators to IV loop diuretics did not lower inpatient mortality or rehospitalization rates compared with loop diuretics alone, and was associated with longer lengths of stay and higher hospitalization costs. Although the lack of complete clinical, socioeconomic, and post-discharge data may have confounded these results, this analysis questions whether currently available IV vasodilators can improve outcomes in hospitalized AHF patients.
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Fu KL, Fan GQ, Han L, Wang XZ, Wang J, Wang YS, Zhong M, Zhang Y, Zhang W, Wang ZH. Impact of type 2 diabetes mellitus on hospitalization costs in older patients with acute myocardial infarction. Clin Interv Aging 2014; 9:711-8. [PMID: 24812498 PMCID: PMC4008285 DOI: 10.2147/cia.s59802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to evaluate the impact of type 2 diabetes mellitus on hospitalization costs in older patients with acute myocardial infarction (MI). Methods Retrospective analysis of data from the case retrieval system of Qilu Hospital of Shandong University located in Jinan city of Shandong Province was done for patients with acute MI from January 1, 2011 to December 31, 2012. Results Stenting was an important factor affecting older patients’ total hospitalization costs (β=0.685, P=0.000) and treatment costs during the follow-up period (duration of hospital stay only, β=0.508, P=0.000). Stenting was also a protective factor in the prevention of acute heart failure (HF) in older patients with acute MI during the follow-up period (odds ratio 0.189, 95% confidence interval 0.059–0.602, P=0.005). Implementation of percutaneous coronary intervention reduced the incidence of acute HF in older inpatients with acute MI (27.8% versus 4.3%, P=0.001) and without diabetes (18.2% versus 3.8%, P=0.001). Moreover, among the elderly, the incremental cost-effectiveness ratio estimate for implementing percutaneous coronary intervention in diabetic patients was higher than in nondiabetic patients. Conclusion Stenting was a protective factor for preventing acute HF in the elderly during the follow-up period. From the perspective of reducing the incidence of acute HF in inpatients, implementation of percutaneous coronary intervention after an acute MI is more cost-effective in older patients with diabetes mellitus than in those without it.
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Affiliation(s)
- Kai-li Fu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Guan-qi Fan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Lu Han
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Xiao-zhen Wang
- Shandong University of Traditional Chinese Medicine, Ji'nan, People's Republic of China
| | - Jia Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Yu-shu Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Ming Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Yun Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Wei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, and Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
| | - Zhi-hao Wang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Ji'nan, People's Republic of China
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Adorka M, Honoré MK, Lubbe M, Serfontein J, Allen K. The Impact of Appropriate Antibiotic Prescribing on Treatment Evaluation Parameters. J Public Health Afr 2013; 4:e2. [PMID: 28299091 PMCID: PMC5345421 DOI: 10.4081/jphia.2013.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 01/18/2023] Open
Abstract
The therapeutic impact of inappropriate prescribing of antibiotics is debatable, particularly in situations where infections are treated empirically with multiply prescribed antibiotics. Prescribers may remain under the illusion that such prescriptions are appropriate on the basis of any observed positive treatment outcomes, even though an antibiotic prescribed in such combination therapy may actually be infective against infecting pathogens. This, inevitably, promotes inappropriate antibiotic prescribing. Prescribers may be motivated to make more conscious attempts to prescribe antibiotics appropriately if it is proven that judicious prescribing of antibiotics has positive impacts on treatment outcomes. The objective of this study was to determine the impact of appropriate prescribing of antibiotics on treatment outcomes, days of patient hospitalization and costs related to antibiotic treatment. Observational data on antibiotic treatment were collected for a one-month period from case notes of all inpatients (n=307) and outpatients (n=865) at five government and mission hospitals in Lesotho. Prescriptions were classified into categories of appropriateness based on extents to which antibiotics were prescribed according to principles. Treatment success rates, mean days of hospitalization and costs of antibiotic treatments of inpatients treated with specified prescription categories were determined. Appropriate prescribing of antibiotics for inpatients had positive impacts on treatment outcomes, patients' days of hospitalization for infections and costs of antibiotic treatments. In outpatient settings, appropriate prescribing of antibiotics failed to show any significant impact on costs of antibiotics. Appropriate prescribing of antibiotics had a positive impact on patients' recovery and costs of antibiotic treatments in inpatient settings.
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Affiliation(s)
- Matthias Adorka
- School of Pharmacy, University of Namibia, Windhoek, Namibia
| | | | - Martie Lubbe
- Medicine Usage in South Africa, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Jan Serfontein
- Medicine Usage in South Africa, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Kirk Allen
- Medical and Pharmaceutical Biotechnology Unit, Research Center in Technology and Design Assistance of Jalisco State (CIATEJ), Guadalajara, Mexico
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Abstract
AIM To evaluate direct hospitalization costs attributable to diabetes and their determinants in a tertiary care hospital in mainland China between 2007 and 2008. METHODS A retrospective study of the hospitalization expenses for 489 inpatients with diabetes from June 2007 to July 2008 was conducted. All related cost components were defined and valued at the most detailed levels. RESULTS Median cost was 5307.8 RMB (range 3672.8-8193.2 RMB). The costs for biochemical tests (28%), pharmacy (26%), and therapies and supplies (21%) were the top 3, about 75% in total expenses. The expenses for the antihyperglycemic treatment alone accounted for 27.6% of total hospitalization expenses. Insulin treatment (P < .001), complication number (P < .001), length of hospitalization (P < .001), diabetes duration (P = .023), and hemoglobin A1C (P = .040) were the main factors affecting costs. CONCLUSIONS Antihyperglycemic treatment expenses represent a minority of total costs; major costs are due to treatment of complications.
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Affiliation(s)
- Mingjuan He
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Jingdong Ma
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Daowen Wang
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xuefeng Yu
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
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Abstract
Heart failure, a major cause of morbidity and mortality among the elderly, is a serious public health problem. As the population ages and the prevalence of heart failure increases, expenditures related to the care of these patients will climb dramatically. As a result, the health care industry must develop strategies to contain this staggering economic burden. Strategies may include adopting approaches for preventing heart failure and implementing new treatment modalities with proven efficacy into large-scale clinical practice. Successful implementation of these strategies will require intensive physician and patient education and development of innovative approaches to fund support services.
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Affiliation(s)
- J B O'Connell
- Department of Internal Medicine, University Health Center, Wayne State University, Detroit, Michigan 48201, USA
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