scholarly journals Economic Impact of Ventilator-Associated Pneumonia in a Large Matched Cohort

2012 ◽  
Vol 33 (3) ◽  
pp. 250-256 ◽  
Author(s):  
Marin H. Kollef ◽  
Cindy W. Hamilton ◽  
Frank R. Ernst
Keyword(s):  
Mechanical Ventilation ◽  
Economic Impact ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Cost Effective ◽  
The United States ◽  
Absolute Difference ◽  
Ventilator Associated Pneumonia ◽  
Matched Cohort ◽  
Hospitalization Costs

Objective.To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs.Design.Retrospective matched cohort study.Setting.Premier database of hospitals in the United States.Patients.Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009.Methods.VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods.Results.Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP (n = 2,144) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all P< .0001) than patients without VAP (n = 2,144). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP (P< .0001), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; P<.0001).Conclusions.Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.Infect Control Hosp Epidemiol 2012;33(3):250-256

Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia

2005 ◽  
Vol 14 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Mary Jo Grap ◽  
Cindy L. Munro ◽  
Russell S. Hummel ◽  
R.K. Elswick ◽  
Jessica L. McKinney ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Medical Records ◽  
Pulmonary Infection ◽  
Severity Of Illness ◽  
Clinical Pulmonary Infection Score ◽  
Ventilator Associated Pneumonia ◽  
Entire Study ◽  
System Data ◽  
The Mean ◽  
The Relationship

• Background Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empirical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. • Objective To describe the relationship between backrest elevation and development of ventilator-associated pneumonia. • Methods A nonexperimental, longitudinal, descriptive design was used. The Clinical Pulmonary Infection Score was used to determine ventilator-associated pneumonia. Backrest elevation was measured continuously with a transducer system. Data were obtained from laboratory results and medical records from the start of mechanical ventilation up to 7 days. • Results Sixty-six subjects were monitored (276 patient days). Mean backrest elevation for the entire study period was 21.7°. Backrest elevations were less than 30° 72% of the time and less than 10° 39% of the time. The mean Clinical Pulmonary Infection Score increased but not significantly, and backrest elevation had no direct effect on mean scores. A model for predicting the Clinical Pulmonary Infection Score at day 4 included baseline score, percentage of time spent at less than 30° on study day 1, and score on the Acute Physiology and Chronic Health Evaluation II, explaining 81% of the variability (F=7.31, P=.003). • Conclusions Subjects spent the majority of the time at backrest elevations less than 30°. Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia.

scholarly journals The effect of face mask mandates during the COVID-19 pandemic on the rate of mask use in the United States

2020 ◽  
Author(s):  
Michael J. Maloney
Keyword(s):  
United States ◽  
Economic Impact ◽  
Cost Effective ◽  
Face Mask ◽  
Public Spaces ◽  
The United States ◽  
State Governments ◽  
Strongly Correlated ◽  
Effective Measure ◽  
Cost Effective Measure

ABSTRACTAs COVID-19 continues to spread throughout the United States, there has been a search for policies to prevent individual infections, to slow the spread of the virus in general, and to mitigate the economic impact of the pandemic. Masks have proven to be a cost-effective measure in all regards, and as such some state governments have begun to mandate their use. However, while the efficacy of masks has been demonstrated, the efficacy of public policies which mandate the use of masks has not been demonstrated. This paper compares the rates of mask use in counties as defined by state policy. It finds that state mandates are strongly correlated with higher rates of mask use, and that mandating use by all individuals in public spaces is more effective than a less comprehensive mandate for mask use by all public facing employees.

Race Impacts Outcomes of Patients With Firearm Injuries

2020 ◽  
Vol 86 (9) ◽  
pp. 1113-1118
Author(s):  
Heather Peluso ◽  
John D. Cull ◽  
Marwan S. Abougergi
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Traumatic Shock ◽  
Hospital Length Of Stay ◽  
Firearm Injuries ◽  
Black Patients ◽  
Hospitalization Costs

Background To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. Methods The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). Results The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). Discussion Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.

A cost-effectiveness analysis of primary prophylaxis (PP) versus secondary prophylaxis (SP) with biosimilar myeloid growth factors (MGFs) for preventing chemotherapy-induced febrile neutropenia (FN) in non-Hodgkin lymphoma (NHL) patients at intermediate risk.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 107-107
Author(s):  
Gary H. Lyman ◽  
Dylan Mezzio ◽  
Edward C. Li ◽  
Kim Campbell ◽  
Sanjeev Balu
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
The United States ◽  
Secondary Prophylaxis ◽  
Sensitivity Analyses ◽  
Intermediate Risk ◽  
Related Factors ◽  
Hospitalization Costs

107 Background: Historically, PP with a MGF was recommended in patients with a ≥40% risk for developing chemotherapy-induced FN, based on clinical and regimen-related factors. Previous economic studies provided evidence to lower the threshold to 20%, the current high-risk threshold listed by practice guidelines. Biosimilar MGFs, such as filgrastim-sndz or LA-EP2006 (a proposed pegfilgrastim biosimilar), offer an opportunity to evaluate whether it is cost-effective to further lower the threshold for intermediate-risk regimens (i.e., 10-20% FN risk). Methods: A Markov model was constructed to evaluate the total costs and clinical outcomes of biosimilar or reference MGFs when used as PP vs. SP in patients 55 years old with NHL receiving 6 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with no additional FN risk factors. Model inputs, including MGF efficacy and acquisition costs, were estimated from publically available data and literature, as were FN hospitalization costs and clinical utilities. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a payer perspective within the United States. Deterministic and probabilistic sensitivity analyses were conducted. Results: Use of filgrastim-sndz as PP vs. SP provided an additional 0.130 QALYs (0.144 LYS) at an incremental cost of $5,999. The ICERs were $50,676, $41,761, and $46,207 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. Using LA-EP2006 as PP vs. SP provided an additional 0.166 QALYs (0.184 LYS) at an incremental cost of $17,648. The ICERs were $123,840, $95,963, and $106,265 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. Conclusions: Within NHL patients receiving R-CHOP at an intermediate risk for FN, PP with filgrastim-sndz and LA-EP2006 are cost-effective compared to their respective use as SP based on a cost-effectiveness threshold of $150,000/QALY.

scholarly journals July Effect on Mortality and Complications in Patients With ARDS in US Teaching Hospitals

2021 ◽  
Vol 30 (4) ◽  
pp. e64-e70
Author(s):  
Titilope Olanipekun ◽  
Abimbola Chris-Olaiya ◽  
Shawn Esperti ◽  
Vinod Nambudiri ◽  
Richard Duff ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Bloodstream Infection ◽  
The United States ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Ventilator Associated Pneumonia ◽  
Central Catheter ◽  
Difference In Differences ◽  
July Effect ◽  
States Experience

Background Each July, teaching hospitals in the United States experience an influx of new resident and fellow physicians. It has been theorized that this occurrence may be associated with increased patient mortality, complication rates, and health care resource use, a phenomenon known as the “July effect.” Objective To assess the existence of a July effect in clinical outcomes of patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation in the intensive care unit in US teaching hospitals. Methods The National Inpatient Sample database was queried for all adult patients with ARDS who received mechanical ventilation from 2012 to 2014. Using a multivariate difference-in-differences (DID) model, differences in mortality, ventilator-associated pneumonia, iatrogenic pneumothorax, central catheter–associated bloodstream infection, and Clostridium difficile infection were compared between teaching and nonteaching hospitals during April-May and July-August. Results There were 70 535 and 43 175 hospitalizations meeting study criteria in teaching and nonteaching hospitals, respectively. Multivariate analyses revealed no differential effect on the rates of all-cause inpatient mortality (DID, 0.66; 95% CI, −0.42 to 1.75), C difficile infection (DID, 0.29; 95% CI, −0.19 to 0.78), central catheter–associated bloodstream infection (DID, 0.14; 95% CI, −0.04 to 0.33), iatrogenic pneumothorax (DID, 0.00; 95% CI, −0.25 to 0.24), ventilator-associated pneumonia (DID, 0.22; 95% CI, −0.05 to 0.49), and any complication (DID, 0.60; 95% CI, −0.01 to 1.20) for July-August versus April-May in teaching hospitals compared with nonteaching hospitals. Conclusion This study did not show a differential July effect on mortality outcomes and complication rates in ARDS patients receiving mechanical ventilation in teaching hospitals compared with nonteaching hospitals.

Hospitalization Costs and Outcomes of Open, Laparoscopic, and Robotic Liver Resections

2021 ◽  
pp. 000313482110110
Author(s):  
Hassan Aziz ◽  
Kamil Hanna ◽  
Nassim Lashkari ◽  
Noor-Us-Sabah Ahmad ◽  
Yuri Genyk ◽  
...  
Keyword(s):  
Liver Resection ◽  
Laparoscopic Approach ◽  
Cost Effective ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Financial Benefit ◽  
Readmission Rates ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
Hospitalization Costs

Introduction Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach. Methods We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs. Results 3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission. Conclusions There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

scholarly journals Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel K. Lim ◽  
Alain Tremblay ◽  
Shengjie Lu ◽  
Ranjani Somayaji
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Bronchial Artery ◽  
Hospital Costs ◽  
The United States ◽  
Hospital Death ◽  
Bronchial Artery Embolization ◽  
Artery Embolization ◽  
Hospitalization Costs

Abstract Background The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs. Methods The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs. Results There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs. Conclusion Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.

Abstract 3138: Hospitalization Costs for Acute Ischemic Stroke Patients Treated with Endovascular Embolectomy in the United States

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
David F Kallmes ◽  
Giuseppe Lanzino ◽  
Alejandro A Rabinstein ◽  
Harry J Cloft
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Hospital Costs ◽  
The United States ◽  
Group Code ◽  
Stroke Patients ◽  
Good Outcome ◽  
Major Complications ◽  
Hospitalization Costs ◽  
Related Group

Background and Purpose- It is important to know the costs for hospitalization for endovascular embolectomy patients so that comparisons can be made to payments to hospitals. Methods- Using the National Inpatient Sample, we evaluated the costs for hospitalization for patients treated with endovascular embolectomy in the United States from 2006-2008. The primary endpoint examined in this study was total hospital costs, and these were correlated with clinical outcome. Hospitalization costs were then compared with Medicare payments for their respective outcomes. MS-DRG 24 was the diagnostic related group code (DRG) for mechanical embolectomy with good outcome and MS-DRG 23 was the DRG code for mechanical embolectomy with major complications. Medicare payments were available at http://www.cms.hhs.gov . Results- A total of 3864 patients received endovascular embolectomy. 1649 patients were <65 years old and 2205 patients were ≥65 years old. Median hospital costs in 2008 dollars were $36,999 (IQR $26,662-$56,405) for patients with good outcome, $50,628 (IQR $33,135-$76,063) for patients with severe disability, and $35,109 (IQR $25,053-$62,621) for patients with mortality. Reimbursement in the year 2008 for DRG 24 (good outcome) was $22075 and reimbursement for DRG 23 (major complications) was $26639. Conclusions- Our study of the NIS shows that hospitalization costs in the United States for ischemic stroke patients treated with endovascular embolectomy are rather high, probably due to the serious nature of their illness. Medicare payments have not been adequate in reimbursing these hospitalizations. Further work is needed to ensure the future reconciliation of costs with payments.

Review of the Literature on the Costs Associated With Acute Kidney Injury

2019 ◽  
Vol 32 (3) ◽  
pp. 292-302 ◽  
Author(s):  
Joseph F. Dasta ◽  
Sandra Kane-Gill
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Economic Impact ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Kidney Injury ◽  
The United States ◽  
Patient Specific ◽  
Major Surgery ◽  
Total Hospital

Acute kidney injury (AKI) develops in 8% to 16% of hospital admissions. These patients exhibit a 4- to 10-fold increase in mortality and prolonged hospital stays. There is a dearth of information on the economics of AKI, especially in critically ill patients whose health-care costs are already high. It is important that pharmacists understand the economic impact of AKI to optimally prevent and treat AKI occurrence, thus reducing total hospital costs. Authors used MEDLINE, PubMed, and Google Scholar searches up to April 2019. Inpatient AKI affects an estimated 498 000 patients in the United States with its annual cost from $4.7 to $24.0 billion. Average patient costs of AKI in the intensive care unit are generally double than those of non-AKI patients. High AKI severity portends a higher cost. Total hospital costs in patients with AKI ranged from $29 700 in cardiac surgery patients to $80 400 in cardiogenic shock. Incremental increases of cost range from $9400 in major surgery patients and up to $81 000 in nonsurviving dialysis patients. The enormity of the clinical and economic impact of AKI should be a call to action by pharmacists to expeditiously select patient-specific therapies to prevent and treat AKI, and thus reduce its economic burden on an already fragile health-care system.

scholarly journals Intra-articular Hyaluronic Acid for Osteoarthritis of the Knee in the United States: A Systematic Review of Economic Evaluations

2021 ◽  
Vol 14 ◽  
pp. 117954412110472
Author(s):  
Margaret Mordin ◽  
William Parrish ◽  
Catherine Masaquel ◽  
Brad Bisson ◽  
Catherine Copley-Merriman
Keyword(s):  
United States ◽  
Hyaluronic Acid ◽  
Literature Review ◽  
Economic Impact ◽  
Cost Effective ◽  
The United States ◽  
Economic Evaluations ◽  
Knee Oa ◽  
Pain Medications ◽  
Number Of Patients

Background: The economic impact of intra-articular hyaluronic acid (IAHA) for the treatment of knee pain associated with osteoarthritis (OA) has been evaluated in the United States, but not systematically summarized. Objective: We reviewed the literature to determine the economic impact of IAHA for pain associated with knee OA in the United States. Methods: A literature review was performed in PubMed (including MEDLINE and MEDLINE In-Process), Embase, the Cochrane Database of Systematic Reviews, and National Health Service Economic Evaluation Database and was limited to English language human studies published from January 2000 to October 2020. Results: The literature search identified 215 unique abstracts; of these, 47 were selected for full-text review and 21 studies met the inclusion criteria. Intra-articular hyaluronic acid injections delayed progression to total knee arthroplasty (TKA), and repeated courses of treatment successfully delayed TKA by more than 5 years. Intra-articular hyaluronic acid was found to reduce the use of pain medications overall and reduce the number of patients receiving opioid prescriptions by 6% ( P < .001). Several studies showed that IAHA is more cost-effective in treating pain associated with knee OA compared with conventional care with nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and corticosteroids, and several authors concluded that IAHA should be the dominant treatment strategy. Conclusions: Current studies suggest that IAHA may reduce the use of pain medications, such as NSAIDs and opioids, and impact time to TKA procedures, thus potentially decreasing overall treatment costs of knee OA over time. Furthermore, IAHA was determined to be cost-effective against NSAIDs, corticosteroids, analgesics, and conservative treatment. As the safety and efficacy of IAHA for knee OA have been well established, the findings from our literature review may be used to inform future economic evaluations.

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