The effect of age and sex on cost of inpatient facility encounters among patients with multiple sclerosis.

OBJECTIVE: To explore the effect of age and sex on cost of all-cause and multiple sclerosis (MS)-related inpatient facility encounters. METHODS: Adult patients with an initial MS diagnosis were identified from a national managed-care database (IMS LifeLink Health Plans Database). The analysis included newly diagnosed MS patients with 12 months insurance eligibility before and after their first MS diagnosis. Inpatient facility encounters (stays) were analyzed for all-cause and MS-related events (ICD-9-CM = 340.XX), other demyelinating CNS disease (ICD-9-CM = 341.XX), rehabilitation (ICD-9-CM = V57.89), and a group of symptom-related diagnoses. Costs and length of stay were evaluated using a general linear model controlling for age and sex. RESULTS: A total of 57,236 patients met study criteria; 74.3% were female. Mean age for females was 45.5 years and for males it was 47.5 years. In total, 17.0% had an all-cause inpatient stay in the 360-day post index, and 3.2% had an in patient stay with a MS relapse-related diagnosis as primary discharge diagnosis. Additional MS-related diagnoses that led to inpatient stays included other demyelinating CNS disease (0.3%), symptom-related diagnoses (1.0%), and rehabilitation (1.1%). All-cause inpatient cost was higher for males vs females across all age groups; however, cost for females increased at a greater rate as age increased (p = 0.0007). Symptom-related inpatient cost was flat for males, was lower for females than males at an average age of 30, and was greater for females than males at an average age of 60 (p = 0.0199). Cost for MS inpatient stays ($11,931), other demyelinating CNS-related stays ($14,931), and rehabilitation ($23,643) did not differ by age and sex. The average cost for any MS-related relapse inpatient stay was $13,761 and varied with increasing age (p < 0.0001). CONCLUSION: Burden of illness for relapse among MS patients is substantial. Costs vary by age and sex depending on the discharge diagnosis. Inclusion of symptom-related and rehabilitation inpatient stays may account for an under-recognized proportion of total expenditures.

Comparative hospital economics and patient presentation: vertebroplasty and kyphoplasty for the treatment of vertebral compression fracture.

BACKGROUND AND PURPOSE: Previous studies evaluating vertebral augmentation procedure costs have not made detailed comparisons between vertebroplasty and kyphoplasty. Our study contrasts hospital costs for vertebroplasty versus kyphoplasty for the treatment of vertebral compression fractures in routine clinical practice in the United States. MATERIALS AND METHODS: This retrospective cohort study analyzed 2007-2008 hospital discharge and billing records from the Premier Perspective data base. The primary outcome variable, differences in total hospital cost between vertebroplasty and kyphoplasty, was assessed by using analysis of covariance. RESULTS: Three thousand six hundred seventeen patients received vertebroplasty (64% inpatient, 36% outpatient), and 8118 received kyphoplasty (54% inpatient, 46% outpatient). Approximately 75% were women, and most were white. Mean total unadjusted inpatient costs were $9837 for vertebroplasty versus $13 187 for kyphoplasty (P < .0001). Outpatient vertebroplasty costs were $3319 versus $8100 for kyphoplasty (P < .0001). Lower vertebroplasty costs were largely due to differences in hospital supply and OR. Mean vertebroplasty OR costs were $73.60 (anesthesia), $112.06 (recovery room), and $990.12 (surgery) versus $172.16 (anesthesia), $257.47 (recovery room), and $1,471.49 (surgery) with kyphoplasty. Adjustments for age, sex, admission status, and disease severity accentuated the differences. Mean adjusted inpatient costs were $11 386 for vertebroplasty versus $16 182 for kyphoplasty (P < .0001), and outpatient costs were $2997 for vertebroplasty versus $7010 for kyphoplasty (P < .0001). After adjustments for the same covariates, length-of-stay differences were no longer evident (P = .4945). CONCLUSIONS: Performing vertebroplasty versus kyphoplasty reduces hospital costs by nearly $5000 for inpatient procedures and by more than $4000 for outpatient procedures.

Economic benefit of a 1-day reduction in hospital stay for community-acquired pneumonia (CAP).

OBJECTIVE: As a component of healthcare reform, payers, hospital administrators, and physicians are looking for ways to reduce hospital expenditures and improve efficiency. The economic benefit of a reduced hospital stay must be weighed against the cost of the treatment or process necessary to achieve the reduced length of stay (LOS). The objective of this paper was to estimate the potential economic benefit of a reduction in inpatient hospital LOS for a common type of admission, community acquired pneumonia (CAP). RESEARCH DESIGN AND METHODS: Data for this study were from the CAP hospital admissions selected from the 2006 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Potential savings associated with a 1 day reduction in CAP LOS were estimated using three methods: (1) average cost, (2) weighted-average incremental cost of an additional day, and (3) weighted-average predicted mean costs from regression models which were used to estimate incremental cost adjusting for hospitalization characteristics. MAIN OUTCOME MEASURES: Cost per day of CAP hospitalization. RESULTS: A total of 1,471,295 CAP admissions qualified for the analysis. The cost for each day of reduction in LOS in 2009 US dollars was $2273, $2373, and $2319 for the three methods: simple average, incremental, and regression, respectively. Subgroup analysis and regression analysis indicated higher costs were identified: in patients who died in the hospital, had hospital stays in the Northeast or West, and in large hospitals. Longer CAP hospitalizations had a higher cost per additional day. Limitations include those typically associated with the use of administrative claims (e.g., lack of clinical detail, issues related to diagnosis coding). CONCLUSIONS: Eliminating a day during the course of a CAP admission is potentially worth $2273-2373 in economic benefits (2009 dollars). As we strive for greater efficiency in healthcare delivery, changes in processes and/or improved diagnostics or treatments may potentially achieve a reduction in the length of stay. The cost of such changes or improvements must be weighed against the economic benefit of a shorter hospitalization.