The economic burden of stomas in the UK: a retrospective observational study of health records and hospital encounters.

BACKGROUND: Stomas divert waste from the small intestine (ileostomy), large intestine (colostomy) or ureters (urostomy), and complications are common. AIMS: This study evaluated healthcare resource utilisation (HCRU) and costs of stomas from a UK perspective. METHODS: This was a retrospective observational study of adults with new stomas (New Stoma Group) or new/existing stomas and >6 months of follow-up (Established Stoma Group) using health records linked with hospital encounters (January 2009-December 2018). Age- and sex-matched controls were identified for each stoma case (1:50). FINDINGS: Both the New (n=8533) and Established (n=9397) stoma groups had significantly higher HCRU (all P<0.0001) and associated costs (all P<0.01), driven by inpatient admissions. New Stoma Group: colostomy versus controls, £3227 versus £99 per person; ileostomy, £2576 versus £78 per person; and urostomy, £2850 versus £110 per person (all P<0.0001). Findings were similar in the Established Stoma Group. CONCLUSION: Stomas are associated with a substantial economic burden in the UK driven by hospital care. (Supplementary data tables can be obtained from the authors.).

The cost of dysphagia in geriatric patients.

OBJECTIVES: To estimate the annual cost at the hospital and in the municipality (social care) due to dysphagia in geriatric patients. DESIGN: Retrospective cost analysis of geriatric patients with dysphagia versus geriatric patients without dysphagia 1 year before hospitalization. SETTING: North Denmark Regional Hospital, Hjørring Municipality, Frederikshavn Municipality, and Brønderslev Municipality. SUBJECTS: A total of 258 hospitalized patients, 60 years or older, acute hospitalized in the geriatric department. MATERIALS AND METHODS: Volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for data collection. A Charlson Comorbidity Index score measured comorbidity, and functional status was measured by Barthel-100. To investigate the cost of dysphagia, patient-specific data on health care consumption at the hospital and in the municipality (nursing, home care, and training) were collected from medical registers and records 1 year before hospitalization including the hospitalization for screening for dysphagia. Multiple linear regression analyses were conducted to determine the relationship between dysphagia and hospital and municipality costs, respectively, adjusting for age, gender, and comorbidity. RESULTS: Patients with dysphagia were significantly costlier than patients without dysphagia in both hospital (p=0.013) and municipality costs (p=0.028) compared to patients without dysphagia. Adjusted annual hospital costs in patients with dysphagia were 27,347 DKK (3,677 EUR, 4,282 USD) higher than patients without dysphagia at the hospital, and annual health care costs in the municipality were 46,044 DKK (6,192 EUR, 7,209 USD) higher. CONCLUSION: Geriatric patients with dysphagia were significantly costlier for both hospital and municipality costs compared to geriatric patients without dysphagia.