Objectives: We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator(ICD) implantation in general practice, and estimate the incremental costs of those complica...Objectives: We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator(ICD) implantation in general practice, and estimate the incremental costs of those complications to the health care system. Background: Cardioverter-defibrillator implantation rates are rising quickly. Little has been published regarding the outcomes and costs of these procedures in unselected populations. Methods: Using Medicare Provider Analysis and Review(MedPAR) files, we identified 30,984 admissions containing procedure codes for new ICD or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003. The frequencies of eight complicating diagnoses during these admissions were determined. Length of stay(LOS) and total hospital costs, derived using whole-hospital cost to charge ratios, were calculated for each admission. The incremental effects of any and each complication on LOS and hospital cost were estimated in multivariable models, adjusting for demographic factors and comorbid conditions. Results: The mean cost for all admissions was ＄42,184(median ＄37,902) with mean LOS of 4.7 days(median 2.0 days). One or more complications were coded in 10.8%of admissions, most commonly “mechanical complication of the ICD”and hemorrhage/hematoma. The occurrence of any complication increased adjusted LOS by 3.4 days and costs by ＄7,251. Each of the individual complications was associated with highly significant increases in both LOS(1 to 10 days) and hospital cost(＄5,000 to ＄20,000). Conclusions: In fiscal 2003, 10.8%of Medicare patients undergoing cardioverter-defibrillator implantation experienced one or more early complications, associated with significant increases in LOS and costs. Efforts to reduce these complications could have significant clinical and financial benefits.展开更多
Background and aims: The potentially high costs of care associated with inflammatory bowel disease (IBD) are recognised but we have little knowledge of the scale, profile, or determinants of these costs in the UK. Thi...Background and aims: The potentially high costs of care associated with inflammatory bowel disease (IBD) are recognised but we have little knowledge of the scale, profile, or determinants of these costs in the UK. This study aimed to describe costs of illness for a group of IBD patients and determine factors associated with increased healthcare costs. Setting: A university hospital serving a target population of approximately 330 000. Patients and methods: A six month cohort of IBD patients receiving any form of secondary care was identified, comprising 307 cases of ulcerative (or indeterminate) colitis and 172 cases of Crohns disease. Demographic and clinical data were abstracted from clinical records and individual resource use was itemised for all attributable costs (including extraintestinal manifestations). Item costs were derived from national and local sources. Cost data were expressed as mean six month costs per patient (with 95%confidence interval (CI)) obtained using non parametric bootstrapping. Determinants of cost were analysed using generalised linear regression modelling. A postal survey of patients was undertaken to examine indirect costs, out of pocket expenses, and primary care visits. Results: Inpatient services (medical and/or surgical) were required by 67 patients (14%) but accounted for 49%of total secondary care costs. Drug costs accounted for less than a quarter of total costs. Individual patient costs ranged from ￡73 to ￡33 254 per six months. Mean (95%CI) six month costs per patient were ￡1256 (￡988, ￡1721) for colitis and ￡1652 (￡1221, ￡2239) for Crohns disease. Hospitalisation, disease severity grade, and disease extent correlated positively with cost of illness but costs were independent of age or sex. Comparedwith quiescent cases of IBD, disease relapse was associated with a 2-3-fold increase in costs for non hospitalised cases and a 20-fold increase in costs for hospitalised cases. Survey data suggested average six month costs were< ￡30 per patient for primary care visits (both diseases) and median loss of earnings were ￡239 for colitis and ￡299 for Crohns disease. Conclusions: This study represents the first detailed characterisation of the scale and determinants of costs of illness for IBD in a British hospital. Hospitalisation affected a minority of sufferers but accounted for half of the total direct costs falling on the healthcare system.展开更多
文摘Objectives: We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator(ICD) implantation in general practice, and estimate the incremental costs of those complications to the health care system. Background: Cardioverter-defibrillator implantation rates are rising quickly. Little has been published regarding the outcomes and costs of these procedures in unselected populations. Methods: Using Medicare Provider Analysis and Review(MedPAR) files, we identified 30,984 admissions containing procedure codes for new ICD or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003. The frequencies of eight complicating diagnoses during these admissions were determined. Length of stay(LOS) and total hospital costs, derived using whole-hospital cost to charge ratios, were calculated for each admission. The incremental effects of any and each complication on LOS and hospital cost were estimated in multivariable models, adjusting for demographic factors and comorbid conditions. Results: The mean cost for all admissions was ＄42,184(median ＄37,902) with mean LOS of 4.7 days(median 2.0 days). One or more complications were coded in 10.8%of admissions, most commonly “mechanical complication of the ICD”and hemorrhage/hematoma. The occurrence of any complication increased adjusted LOS by 3.4 days and costs by ＄7,251. Each of the individual complications was associated with highly significant increases in both LOS(1 to 10 days) and hospital cost(＄5,000 to ＄20,000). Conclusions: In fiscal 2003, 10.8%of Medicare patients undergoing cardioverter-defibrillator implantation experienced one or more early complications, associated with significant increases in LOS and costs. Efforts to reduce these complications could have significant clinical and financial benefits.
文摘Background and aims: The potentially high costs of care associated with inflammatory bowel disease (IBD) are recognised but we have little knowledge of the scale, profile, or determinants of these costs in the UK. This study aimed to describe costs of illness for a group of IBD patients and determine factors associated with increased healthcare costs. Setting: A university hospital serving a target population of approximately 330 000. Patients and methods: A six month cohort of IBD patients receiving any form of secondary care was identified, comprising 307 cases of ulcerative (or indeterminate) colitis and 172 cases of Crohns disease. Demographic and clinical data were abstracted from clinical records and individual resource use was itemised for all attributable costs (including extraintestinal manifestations). Item costs were derived from national and local sources. Cost data were expressed as mean six month costs per patient (with 95%confidence interval (CI)) obtained using non parametric bootstrapping. Determinants of cost were analysed using generalised linear regression modelling. A postal survey of patients was undertaken to examine indirect costs, out of pocket expenses, and primary care visits. Results: Inpatient services (medical and/or surgical) were required by 67 patients (14%) but accounted for 49%of total secondary care costs. Drug costs accounted for less than a quarter of total costs. Individual patient costs ranged from ￡73 to ￡33 254 per six months. Mean (95%CI) six month costs per patient were ￡1256 (￡988, ￡1721) for colitis and ￡1652 (￡1221, ￡2239) for Crohns disease. Hospitalisation, disease severity grade, and disease extent correlated positively with cost of illness but costs were independent of age or sex. Comparedwith quiescent cases of IBD, disease relapse was associated with a 2-3-fold increase in costs for non hospitalised cases and a 20-fold increase in costs for hospitalised cases. Survey data suggested average six month costs were< ￡30 per patient for primary care visits (both diseases) and median loss of earnings were ￡239 for colitis and ￡299 for Crohns disease. Conclusions: This study represents the first detailed characterisation of the scale and determinants of costs of illness for IBD in a British hospital. Hospitalisation affected a minority of sufferers but accounted for half of the total direct costs falling on the healthcare system.
