Examining quality and efficiency of the US healthcare system

Background Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from alcoholic hepatitis and evaluate its financial impact. Methods The National Inpatient Sample (NIS) databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals with age ≥ 21 years were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by NIS. Simple linear regression method was used to assess trends in mortality and length of stay over time. Results We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07 % (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared to 2002 (additional cost per hospitalization $11,044 in 2010 compared to 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (~25% – 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 days in 2002 to 6.1 days in 2010). Conclusion AH-related hospitalization continued to increase during the study period, despite the decreasing in the in-hospital mortality rate. Substantial increases in healthcare cost and utilization among hospitalized AH patients were observed.

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“…It is likely that the rising in hospital charges is secondary to the rising in healthcare cost in the United States over the past decade 16 .…”

Section: Discussionmentioning

confidence: 99%

Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States

Jinjuvadia

Liangpunsakul

2015

Journal of Clinical Gastroenterology

116

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“…In any case, these figures are likely underestimated, since the cost of health care has outpaced inflation 26 .…”

Section: Discussionmentioning

confidence: 99%

Use of the National Health and Nutrition Examination Survey to Calculate the Impact of Obesity and Diabetes on Cost and Prevalence of Urolithiasis in 2030

et al. 2014

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Background The prevalence of urolithiasis and its risk factors such as obesity and diabetes have increased over time. Objective Determine the future cost and prevalence of kidney stones using current and projected estimates for stones, obesity, diabetes, gender, and population rates. Design, Setting, and participants The Stone prevalence in 2000 was estimated from National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 2007–2010. The cost per percent prevalence of stone disease in 2000, calculated using Urologic Diseases in America Project data, was used to estimate the annual cost of stones in 2030, adjusting for inflation and increases in population, stone prevalence, obesity, and diabetes rates. Outcome measurements and statistical analysis The primary outcome was prevalence and cost of stones in 2030. The secondary outcomes were the impact of obesity and diabetes on these values, calculated using ratios for stones by body mass index and diabetes status. Results and limitations The annual cost of stone disease in 2000, adjusted for inflation to 2014 US dollars, was approximately $2.81 billion. After accounting for increased in population and stone prevalence from 2000, the estimated cost of stones in 2007 in 2014 US dollars was $3.79 billion. Future population growth alone would increase the cost of stone disease by $780 million in 2030. Based on projected estimates for 2030, obesity will independently increase stone prevalence by 0.36%, with an annual cost increase of $157 million. Diabetes will independently increase stone prevalence by 0.72, associated with a cost increase of $308 million annually by 2030. NHANES data, however, capture patient self-assessment rather than medical diagnosis, which is a potential bias. Conclusions The rising prevalence of obesity and diabetes, together with population growth, is projected to contribute to dramatic increases in the cost of urolithiasis, with an additional $1.24 billion/yr estimated by 2030. Patient Summary Obesity, diabetes, and population rates will contribute to an estimated $1.24 billion/yr increases in the cost of kidney stones by 2030.

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“…[21] A shift in focus on cost-conscious, high value healthcare is a priority for U.S. policy makers as current healthcare expenditures are unsustainable. [22] Identifying which aspects of perioperative care and the impact of presurgical patient optimization will be criticial for cost reduction. Current data suggests that preoperative intervention strategies can reduce postoperative complications and therefore surgery-associated cost.…”

Section: Discussionmentioning

confidence: 99%

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications

Harris

Osterberg

Sanford

et al. 2016

Urology

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Objective To determine which factors are associated with higher urethroplasty procedural costs and whether they have been increasing or decreasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. Materials and Methods We conducted a retrospective analysis using the 2001–2010 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP Cost-to-Charge Ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression and expressed as Odds Ratios (OR). Results A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated costs was $7321 ($5677–$10000). Patients with multiple comorbid conditions were associated with extreme costs (OR 1.56 95% CI 1.19–2.04, p=0.02) compared to patients with no comorbid disease. Inpatient complications raised the odds of extreme costs OR 3.2 CI 2.14–4.75, p<0.001). Graft urethroplasties were associated with extreme costs (OR 1.78 95% CI 1.2–2.64, p=0.005). Variation in patient age, race, hospital region, bed size, teaching status, payer type, and volume of urethroplasty cases were not associated with extremes of cost. Conclusion Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost.

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Examining quality and efficiency of the US healthcare system

Cited by 38 publications

References 4 publications

Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States

Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States

Use of the National Health and Nutrition Examination Survey to Calculate the Impact of Obesity and Diabetes on Cost and Prevalence of Urolithiasis in 2030

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications

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