Health care costs for adolescents and young adults with cancer: a Wisconsin community-based hospital study between 2005 and 2020

INTRODUCTION

Adolescents and young adults (AYA) with cancer are at risk of high cumulative healthcare system costs potentially associated with poor health and financial outcomes. Although this has been studied at academic centers, little data on AYA costs at community-based practices exist. The goals of this study were to understand direct health care costs for AYA patients, identify factors for high costs, and assess how total health care costs may relate to survival.

METHODS

AYA patients (15-39 years) treated at a community hospital in Wisconsin (USA) between 2005 and 2020 were identified. Patient demographics, cancer characteristics, therapies, support services, and all direct health care charges (including up to 1 year prior to diagnosis to capture any diagnostic workup) were collected. Logistic and Cox proportional hazard regression models identified factors associated with high costs and survival, respectively.

RESULTS

The 388 AYA patients had a median follow-up of 9 years (97% survival). Most were 30-39 years (62%), female (61%), white (95%), diagnosed early-stage (85%), and underwent surgery (83%). Complete health care costs were available for 233 patients (60%). Median total costs per patient were $123 K (range, $73-$215 K). On adjusted analysis, higher direct health care costs (> $125 K) were associated with greater odds of hospital admissions (odds ratio [OR] = 1.7, 95% CI = 1.35-2.27), chemotherapy (OR = 4.1, 95% CI = 1.44-12.70), and breast cancer diagnosis (OR = 3.8, 95% CI = 1.07-14.70). Living farther from the hospital (OR = 0.1, 95% CI = 0.02-0.50), later year of diagnosis (OR = 0.7, 95% CI = 0.55-0.77), and uninsured/unknown insurance status (OR = 0.1, 95% CI = 0.01-0.57) were associated with decreased odds of having higher health care costs. On adjusted analysis, death was associated with greater odds of higher direct health care costs per $125 K (hazards ratio [HR] = 7.9, 95% CI = 2.22-27.80) and radiation (HR = 31.8, 95% CI = 3.15-321) but lower odds of hormone therapy (HR = 0.1, 95% CI = 0.01-0.72) and later year of diagnosis (HR = 0.3, 95% CI = 0.12-0.60).

CONCLUSION

High direct health care costs among AYA patients are associated with hospital admissions, chemotherapy, breast cancer diagnosis, hospital proximity, and earlier year of diagnosis. Death was associated with high direct health care costs, earlier years of diagnosis, and radiation therapy. Total health care costs in community-based hospitals should be considered in the context of AYA patients with cancer.

Clinical and Sociodemographic Profile of Patients With Thyroid Storm: A National Inpatient Sample Database Analysis

Background: Thyroid storm (TS) is a rare, life-threatening disease that is associated with significant mortality. The clinical outcome of these patients has not been evaluated in general practice on a national scale. Our study aimed to find the clinical characteristics and outcomes of patients admitted to community hospitals with TS using the National Inpatient Sample (NIS) database.

Methods: We conducted a retrospective study of adult patients (>=18 years of age) diagnosed with primary and secondary TS from the NIS database from 2012 to 2014. The NIS is the largest all-payer inpatient care database in the United States, containing data on more than seven million hospital stays each year. Statistical analysis performed included Chi-Square test, Wilcoxon two-sample test, Fisher’s exact test and multiple logistic regression with a p-value<0.05 considered significant.

Results: In total, 2,163 hospitalizations with TS were identified. The incidence of TS in hospitalized patients was 11.96 per 100,000 hospitalizations. Compared to all other adult hospitalizations reported over the same period, admission with TS was significantly associated with a higher prevalence in African Americans (31.4% vs 14.7%, p<0.001) as well as concomitant blood diseases (31.4% vs 21.9%, p<0.001), drug use disorder (11.4% vs 8.4%, p<0.001), electrolyte disturbance (36.9% vs 23.8%, p<0.001), and psychosis (38.1% vs 28.5%, p<0.001). Admission with TS was associated with lower prevalence of concomitant cancer (2.5% vs 4.9%, p<0.001) and renal disease (5.6% vs 12.2%, p<0.001), along with a higher risk of death during hospitalization (3.9% vs 2.2%, p<0.001). There was no significant association between TS and GI disease, cardiovascular disease, pulmonary disease or rheumatoid arthritis. Admission with TS was associated with longer average length of stay (TS median: 4 days, Non-TS: 3 days, p<0.001) and higher total hospital charge (TS median: $27,360, Non-TS: $24,346, p<0.001). Additionally, TS had a higher incidence in urban populations with large hospitals.

Overall, inpatient mortality rate was 3.9%. For those with TS, the odds of inpatient death were greater for age group 30-59 compared to <30 (OR 2.916, p=0.026), age group >60 compared to <30 (OR 3.157, p=0.022), males (OR 2.20, p<0.001), those with cancer (OR 6.42, p<0.001), those with electrolyte disturbance (OR 6.12, p<0.001) and those with a neurologic disorder (OR 2.46, p=0.002). Admitted patients with a concomitant psychological disorder had lower odds of death (OR 0.38, p=0.03).

Conclusions: This study identified clinical characteristics associated with TS-related admission including female gender, age 30-59, Caucasian race, and urban populations. Higher mortality was associated with patients 30-59 years and >60 years of age, electrolyte disturbances, blood disease, weight loss, paralysis, cancer, renal disease, and male gender.