Hospitalisation costs of malignant mesothelioma: results from the Italian hospital discharge registry (2001–2018)

ObjectivesThis paper aims to establish hospitalisation costs of mesothelioma in Italy and to evaluate hospital-related trends associated with the 1992 asbestos ban.DesignThis is a retrospective population-based study of Italian hospitalisations treating pleura, peritoneum and pericardium mesothelioma in the period 2001–2018.SettingsPublic and private Italian hospitals reached by the Ministry of Health (coverage close to 100%).Participants157 221 admissions with primary or contributing diagnosis of pleural, peritoneal or hearth cancer discharged from 2001 to 2018.Primary and secondary outcome measures: number, length and cost of hospitalisations with related percentages.ResultsEach year, Italian hospitals treated a mesothelioma in 6025 admissions on average. Mean annual costs by site were €20 293 733, €3183 632 and €40 443 for pleura, peritoneum and pericardium, respectively. Pericardial mesothelioma showed the highest cost per admission (€6117), followed by peritoneal (€4549) and pleural cases (€3809). Percentage of hospitalisation costs attributable to mesothelioma was higher when it is located in pleura (53.4%) and pericardium (51.8%) with respect to peritoneum (41.2%). Overall annual hospitalisation cost, percentages of number and length of admissions showed an inverted U-shape, with maxima (of €25 850 276, 0.064% and 0.096%, respectively) reached in 2011–2013. Mean age at discharge and percentages of surgery and of urgent cases increased over time.ConclusionsThe highest impact of mesothelioma on the National Health System was recorded 20 years after the asbestos ban (2011–2013). Hospitals should expect soon fewer but more severe patients needing more cares. To study the disease prevalence could help assistance planning of next decade.

Effects of hospice palliative care on medical service utilisation by patients on prolonged mechanical ventilation: A nationwide cohort study

Background: Several studies have shown that hospice palliative care interventions for cancer patients can reduce medical utilisation. In Taiwan, 20–25% of mechanical ventilation patients have been on prolonged mechanical ventilation (PMV), but only a few studies have discussed the effectiveness of hospice palliative care on these patients. This study aimed to explore the effectiveness of medical utilisation on patients undergoing PMV in hospice palliative care.Methods: From the Health Insurance database of a nationwide population-based study, we identified patients who had been on mechanical ventilation for over 21 days, were 18 years or older between 2009 to 2017, and had undergone hospice palliative care. The control group was obtained by 1:1 matching using propensity scoring after excluding patients who had participated in palliative care for less than 15 or more than 181 days. Furthermore, we used conditional logistic regression analysis to explore intensive care unit readmission, emergency department presentation, and cardiopulmonary resuscitation incidents, 14 days prior to death.Results: A total of 186,533 new PMV patients aged ≥ 18 years with terminal diseases were admitted between 2009 and 2017. Additionally, the number of patients receiving palliative care increased annually, from 0.6% in 2009 to 41.33% in 2017. The number of prolonged mechanical ventilation during emergency visits (odds ratio [OR]=0.68, 95%CI: 0.63-0.74), intensive care unit hospitalisation (OR=0.59, 95%CI: 0.53-0.46), cardiopulmonary resuscitation (OR=0.40, 95%CI: 0.35-0.46), and total hospitalisation cost (USD 1319.9.57 ± 1821.67 vs. 1544.37 ± 2309.27) was lower in the palliative care group.Conclusion: Patients undergoing PMV whilst in hospice palliative care can significantly reduce total hospitalisation cost, intensive care unit admittance, cardiopulmonary resuscitation utilisation, and medical expenses at ≤14 days prior to death.

A comparative study of transscrotal, transinguinal and laparoscopic orchidopexy for inguinal cryptorchidism

Background A retrospective comparative study was performed on scrotal incision, inguinal incision and laparoscopic orchidopexy. The characteristics of the different surgical methods were analysed. Methods Clinical data of 158 patients with inguinal cryptorchidism admitted to our hospital from January 2017 to January 2018 were retrospectively analysed. Results The operation time in the scrotal incision group was significantly less than that in the inguinal incision group and laparoscopic group (P < 0.05). The length of the operative incision in the scrotal incision group and laparoscopic incision group was shorter than that in the inguinal incision group. There was no significant difference in the postoperative hospitalisation time or hospitalisation cost among the three groups (P > 0.05). The incidence of scrotal haematoma in the scrotal incision group was significantly higher than that in the inguinal incision group and laparoscopic group. There were no complications, such as testicular atrophy, testicular retraction, indirect inguinal hernia, or hydrocele. Conclusions Transscrotal incision, transinguinal incision and laparoscopic orchidopexy are safe for the treatment of inguinal cryptorchidism. Satisfactory early clinical results can be achieved. Rational use of scrotal incision surgery and laparoscopic surgery for cryptorchidism may replace transinguinal surgery and can provide a good cosmetic effect for children.

Cost of hospitalisation and length of stay due to hypoglycaemia in patients with diabetes mellitus: a cross-sectional study

Objective: This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus. Methods: A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient’s perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression. Results: During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p=0.008), and older age was correlated with higher hospitalisation cost (0.207, p=0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p<0.05). In addition, being a male patient (0.394, p<0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p<0.01), but not with higher hospitalisation cost. Conclusions: Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay.

A prospective cross-sectional study to evaluate the economic burden of patients diagnosed with depression in a tertiary care hospital

Background: The objective of the study was to evaluate the cost of care of depression in terms of direct and indirect costs.Methods: 150 patients diagnosed with depression attending psychiatry OPD at Sir J.J. Group of Hospitals, Mumbai, fulfilling the inclusion criteria were explained about the study. Written informed consent were taken. Direct and Indirect costs were recorded in structured case record forms by interviewing the patients. Cost driving factors were identified.Results: Total annual direct cost were INR 6,378.16 which included drug costs, travel expenses, physician’s consultation, cost of investigations, hospitalisation cost while total Indirect costs were INR 16,860 which included days of work both of the patient and the caretaker.Conclusions: The indirect cost was almost thrice the direct costs. Hospitalisation cost and loss of working days due to depression was contributed the most to the direct costs and indirect costs respectively. Economic burden of depression is found out to be 16.30% of per capita gross domestic product in year 2018-19.

Economic and clinical outcomes of the nurse practitioner-led Sydney Adventist Hospital Community Palliative Care Service

ObjectiveThe aim of this study was to assess the clinical, economic and personal impacts of the nurse practitioner-led Sydney Adventist Hospital Community Palliative Care Service (SanCPCS) MethodsParallel economic analysis of usual care was conducted prospectively with patients from the enhanced SanCPCS. A convenient retrospective sample from the initial service was used to determine the impact of the enhanced service on patient care. A time series survey was used with patients and carers from within the expanded service group in order to measure patient outcomes and values as they approached death. ResultsPatients of the SanCPCS were less likely to die in hospital and had fewer hospital admissions. In addition, the service halved the estimated hospitalisation cost per patient, but the length of hospital stay was not affected by the service. The SanCPCS was more beneficial for women in terms of fewer hospital admissions and lower costs. Patients’ choices regarding place of care and death and what was ‘important’ to them changed over time. For instance, patients tended to prefer being at home as they approached death, and being pain free doubled in importance. ConclusionsNurse practitioner-led community palliative care services have the potential to result in significant economic and personal benefits for patients and their families in need of such care. What is known about the topic?National trends show an emphasis on community services with the aim of promoting and supporting the choice of dying at home, and this coincides with drives to reduce hospital costs and length of stay. Community-based palliative care services may offer substantial economic and clinical benefits. What does this paper add?The SanCPCS was the first nurse practitioner-led community-based palliative care service in Australia. The expansion of this service led to significantly fewer admissions and deaths in hospital, and halved the estimated hospitalisation cost per patient. What are implications for practitioners?Nurse practitioner-led models for care in the out-patient or community setting are a logical direction for palliative services through the engagement of specialised providers uniquely trained to support, nurture, guide and educate patients and their carers.

Creation of a novel algorithm to identify patients with Becker and Duchenne muscular dystrophy within an administrative database and application of the algorithm to assess cardiovascular morbidity

BackgroundOutcome analyses in large administrative databases are ideal for rare diseases such as Becker and Duchenne muscular dystrophy. Unfortunately, Becker and Duchenne do not yet have specific International Classification of Disease-9/-10 codes. We hypothesised that an algorithm could accurately identify these patients within administrative data and improve assessment of cardiovascular morbidity.MethodsHospital discharges (n=13,189) for patients with muscular dystrophy classified by International Classification of Disease-9 code: 359.1 were identified from the Pediatric Health Information System database. An identification algorithm was created and then validated at three institutions. Multi-variable generalised linear mixed-effects models were used to estimate the associations of length of stay, hospitalisation cost, and 14-day readmission with age, encounter severity, and respiratory disease accounting for clustering within the hospital.ResultsThe identification algorithm improved identification of patients with Becker and Duchenne from 55% (code 359.1 alone) to 77%. On bi-variate analysis, left ventricular dysfunction and arrhythmia were associated with increased cost of hospitalisation, length of stay, and mortality (p<0.001). After adjustment, Becker and Duchenne patients with left ventricular dysfunction and arrhythmia had increased length of stay with rate ratio 1.4 and 1.2 (p<0.001 and p=0.004) and increased cost of hospitalization with rate ratio 1.4 and 1.4 (both p<0.001).ConclusionsOur algorithm accurately identifies patients with Becker and Duchenne and can be used for future analysis of administrative data. Our analysis demonstrates the significant effects of cardiovascular disease on length of stay and hospitalisation cost in patients with Becker and Duchenne. Better recognition of the contribution of cardiovascular disease during hospitalisation with earlier more intensive evaluation and therapy may help improve outcomes in this patient population.

Economic burden of hospitalisation for congestive heart failure among adults in the Philippines

ObjectivesHospitalisation for congestive heart failure (CHF) was reported to be 1648 cases for every 100 000 patient claims in 2014 in the Philippines; however, there are no data regarding its economic impact. This study determined CHF hospitalisation cost and its total economic burden. It compared the healthcare-related hospitalisation cost from the societal perspective with the payer’s perspective, the Philippine Health Insurance Corporation (PhilHealth).MethodsThis is a cost analysis study. Data were obtained from representative government/private hospitals and a drugstore in all regions of the country. Healthcare costs included cost of diagnostics/treatment, professional fees and other CHF-related hospital charges, while non-healthcare costs included production losses, transportation and food expenses.ResultsThe overall mean healthcare-related cost for CHF hospitalisation (class III) in government hospitals in the Philippines in 2014 was PHP19 340–PHP28 220 (US$436–US$636). In private hospitals, it was PHP28 370–PHP41 800 (US$639–US$941). In comparison, PhilHealth’s coverage/CHF case rate payment is PHP15 700 (US$354). The mean non-healthcare cost was PHP10 700–PHP14 600 (US$241–US$329). Using PhilHealth’s case rate payment and the prevalence of CHF hospitalisation in 2014, the total economic burden was PHP691 522 200 (US$15 574 824). Using the study results on healthcare-related cost meant that the total economic burden for CHF hospitalisation would instead be PHP851 850 000–PHP1 841 563 000 (US$19 185 811–US$41 476 644).ConclusionsThe calculated healthcare-related hospitalisation cost for CHF in the Philippines in 2014 demonstrates the disparity between the actual cost and PhilHealth’s coverage. This implies a need for policymakers to review its coverage to make healthcare delivery affordable.