Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review

Abstract

BackgroundHealthcare systems internationally are under an ever-increasing demand for services that must be delivered in an efficient, effective and affordable manner. Several patient-related and organisational factors influence health-care expenditure and utilisation, including oropharyngeal dysphagia. Here, we present a systematic review of the literature and meta-analyses investigating how oropharyngeal dysphagia influences healthcare utilisation through length of stay (LOS) and cost.MethodsUsing a standardised approach, eight databases were systematically searched for relevant articles reporting on oropharyngeal dysphagia attributable inpatient LOS and healthcare costs through June 2016. Study methodologies were critically appraised and where appropriate, extracted LOS data were analysed in an overall summary statistic.ResultsEleven studies reported on cost data, and 23 studies were included reporting on LOS data. Descriptively, the presence of dysphagia added 40.36% to health care costs across studies. Meta-analysis of all-cause admission data from 13 cohort studies revealed an increased LOS of 2.99 days (95% CI, 2.7, 3.3). A subgroup analysis revealed that admission for stroke resulted in higher and more variable LOS of 4.73 days (95% CI, 2.7, 7.2). Presence of dysphagia across all causes was also statistically significantly different regardless of geographical location: Europe (8.42 days; 95% CI, 4.3; 12.5), North America (3.91 days; 95% CI, 3.3, 4.5). No studies included in meta-analysis were conducted in Asia.ConclusionsThis systematic review demonstrated that the presence of oropharyngeal dysphagia significantly increases healthcare utilisation and cost, highlighting the need to recognise oropharyngeal dysphagia as an important contributor to pressure on healthcare systems.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3376-3) contains supplementary material, which is available to authorized users.

Economic costs of dysphagia among hospitalized patients

“…Patients with swallow impairment have a significant increase in pulmonary risk and mortality rates . The social, health, and economic impacts are substantial . However, the decline in swallow function may happen insidiously with the individual making compensations and adjustments to ameliorate the trouble they are experiencing.…”

“…3 The social, health, and economic impacts are substantial. 6 However, the decline in swallow function may happen insidiously with the individual making compensations and adjustments to ameliorate the trouble they are experiencing. Only a small proportion of those with swallow deficits seek and receive specific treatment for their symptoms, which often coexist with other disorders and can be affected by medications, general health, and diet.…”

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

“…In addition to morbidity and mortality, there is monetary cost to dysphagia that affects healthcare systems and individuals worldwide. A systemic review of OD on healthcare costs and length of stay by Attrill et al found “the presence of dysphagia added 40.36% to healthcare costs across studies.” A study by Westmark, Melgaard, Rethmeier, and Ehlers looked at costs in and out of the hospital setting and found that in the geriatric dysphagia population, costs were significantly higher for those with a dysphagia diagnosis. As per Bhattacharyya's analysis of the National Health Interview Survey, it was noted that a minority of the number of persons with self‐reported dysphagia sought healthcare, and adults with reported swallowing difficulties indicated 11.6 ± 2.0 missed workdays compared with 3.4 ± 0.1 missed days per year for individuals without reported swallowing difficulty …”

“…In addition to morbidity and mortality, there is monetary cost to dysphagia that affects healthcare systems and individuals worldwide. A systemic review of OD on healthcare costs and length of stay by Attrill et al 43 found "the presence of dysphagia added 40.36% to healthcare costs across studies." A study by Westmark, Melgaard, Rethmeier, and Ehlers 44 looked at costs in and out of the hospital setting and found that in the geriatric dysphagia population, costs were significantly higher for those with a dysphagia diagnosis.…”

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

“…Until recently there had been no systematic investigation of the impact of oropharyngeal dysphagia on healthcare utilisation and its influence on cost. However, a recent systematic review has highlighted the need to recognise oropharyngeal dysphagia as an important contributor to pressure on healthcare systems and for economic analysis to be included in research evaluating dysphagia (Attrill, White, Murray, Hammond, & Doeltgen, 2018). An increase of 40.36% was found in dysphagia related expenditure compared with non-dysphagic groups, and dysphagia related length of stay was significantly longer with a mean addition of four extra days.…”