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Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach.

ABSTRACT: INTRODUCTION:Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown. The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System. METHODS:Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months. The applied microcosting approach was based on healthcare resource data, collected from patients' charts upon ward admission until discharge, and unitary costs from official/public data sources. Absenteeism was also estimated for active workers on the basis of the human capital approach. RESULTS:Of the 176 patients with diabetes mellitus enrolled, 86% had type 2 diabetes. Half of the patients (50.0%) were on insulin-based therapy, followed by 30.1% on a secretagogue-based regimen, 9.7% on non-secretagogue therapy, and 10.2% on a combination of insulin and secretagogue. Overall mean costs per patient were medication, 45.45 €; laboratory analysis, 218.14 €; examinations, 64.91 €; physician and nurse time, 268.55 € and 673.39 €, respectively. Bed occupancy was the main cost driver (772.09 €) and indirect cost averaged 140.44 €. Overall, the cost per hypoglycemia episode leading to hospitalization averaged 2042.52 € (range 194.76-16,762.87 €). Patients treated with insulin-based regimens (2267.76 €) and type 2 diabetes (2051.29 €) had the highest mean costs. The mean cost increased with repeated hypoglycemic events (2191.67 €), correlated complications (2109.26 €), and death (5253.38 €). CONCLUSION:HIPOS-WARD's findings confirm and support both the substantial clinical and economic impact of hospitalization due to hypoglycemia in Portugal.

SUBMITTER: Ferreira JP

PROVIDER: S-EPMC7509029 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach.

Ferreira João P JP Araújo Francisco F Dores Jorge J Santos Lèlita L Pape Estevão E Reis Mónica M Chipepo Árcia Á Nascimento Edite E Baptista Ana A Pires Vanessa V Marques Carlos C Lages Adriana S AS Conceição João J Laires Pedro A PA Pelicano-Romano João J Alão Sílvia S

Diabetes therapy : research, treatment and education of diabetes and related disorders 20200711 10

<h4>Introduction</h4>Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown. The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System.<h4>Methods</h4>Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months. The applied microcost ...[more]

PMID: 32654070

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Project description:BackgroundHospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood.MethodsWe conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors.ResultsAmong the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients' experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors.ConclusionsOur findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life's demands.

Project description:BackgroundPulmonary tuberculosis (PTB) is a prevalent chronic disease associated with a significant economic burden on patients. Using machine learning to predict hospitalization costs can allocate medical resources effectively and optimize the cost structure rationally, so as to control the hospitalization costs of patients better.MethodsThis research analyzed data (2020-2022) from a Kashgar pulmonary hospital's information system, involving 9570 eligible PTB patients. SPSS 26.0 was used for multiple regression analysis, while Python 3.7 was used for random forest regression (RFR) and MLP. The training set included data from 2020 and 2021, while the test set included data from 2022. The models predicted seven various costs related to PTB patients, including diagnostic cost, medical service cost, material cost, treatment cost, drug cost, other cost, and total hospitalization cost. The model's predictive performance was evaluated using R-square (R2), Root Mean Squared Error (RMSE), and Mean Absolute Error (MAE) metrics.ResultsAmong the 9570 PTB patients included in the study, the median and quartile of total hospitalization cost were 13,150.45 (9891.34, 19,648.48) yuan. Nine factors, including age, marital status, admission condition, length of hospital stay, initial treatment, presence of other diseases, transfer, drug resistance, and admission department, significantly influenced hospitalization costs for PTB patients. Overall, MLP demonstrated superior performance in most cost predictions, outperforming RFR and multiple regression; The performance of RFR is between MLP and multiple regression; The predictive performance of multiple regression is the lowest, but it shows the best results for Other costs.ConclusionThe MLP can effectively leverage patient information and accurately predict various hospitalization costs, achieving a rationalized structure of hospitalization costs by adjusting higher-cost inpatient items and balancing different cost categories. The insights of this predictive model also hold relevance for research in other medical conditions.

Project description:ImportanceDelayed appendicitis diagnosis is associated with worse outcomes. Appendicitis hospital care costs associated with delayed diagnosis are unknown.ObjectiveTo determine whether delayed appendicitis diagnosis was associated with increased appendicitis hospital care costs.Design, setting, and participantsThis cohort study used data from patients receiving an appendectomy aged 18 to 64 years in 5 states (Florida, Maryland, Massachusetts, New York, Wisconsin) that were captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases for the years 2016 and 2017 with no additional follow-up. Data were analyzed January through April 2023.ExposuresDelayed diagnosis was defined as a previous emergency department or inpatient hospital encounter with an abdominal diagnosis other than appendicitis, and no intervention 7 days prior to appendectomy encounter.Main outcomes and measuresThe main outcome was appendicitis hospital care costs. This was calculated from aggregated charges of encounters 7 days prior to appendectomy, the appendectomy encounter, and 30 days postoperatively. Cost-to-charge ratios were applied to charges to obtain costs, which were then adjusted for wage index, inflation to 2022 US dollar, and with extreme outliers winsorized. A multivariable Poisson regression estimated appendicitis hospital care costs associated with a delayed diagnosis while controlling for age, sex, race and ethnicity, insurance status, care discontinuity, income quartile, hospital size, teaching status, medical school affiliation, percentage of Black and Hispanic patient discharges, core-based statistical area, and state.ResultsThere were 76 183 patients (38 939 female [51.1%]; 2192 Asian or Pacific Islander [2.9%], 14 132 Hispanic [18.5%], 8195 non-Hispanic Black [10.8%], 46 949 non-Hispanic White [61.6%]) underwent appendectomy, and 2045 (2.7%) had a delayed diagnosis. Delayed diagnosis patients had median (IQR) unadjusted cost of $11 099 ($6752-$17 740) compared with $9177 ($5575-$14 481) for nondelayed (P < .001). Patients with delayed diagnosis had 1.23 times (95% CI, 1.16-1.28 times) adjusted increased appendicitis hospital care costs. The mean marginal cost of delayed diagnosis was $2712 (95% CI, $2083-$3342). Even controlling for delayed diagnosis, non-Hispanic Black patients had 1.22 times (95% CI, 1.17-1.28 times) the adjusted increased appendicitis hospital care costs compared with non-Hispanic White patients.Conclusions and relevanceIn this cohort study, delayed diagnosis of appendicitis was associated with increased hospital care costs.

Project description:The objective of this study was to carry out a large population-based study to understand the factors associated with hypoglycemia-related hospitalizations among older Korean adults with diabetes mellitus.This study analyzed data from a subset of the 2013 Health Insurance and Review and Assessment service-Adult Patient Sample. A total of 307,170 subjects, comprising 41.7% men and 58.3% women, had diabetes mellitus. Hypertension (80.8%) was the most common comorbidity, and dyslipidemia (59.0%) and ischemic heart disease (21.3%) were also prevalent. Approximately half of the patients with diabetes had >2 comorbidities, and two-thirds of the patients had >3 comorbidities. The proportion of patients taking insulin or sulfonylureas was 54.9%, and 23.2% of the patients were taking other medications. About 21.9% of the patients were treated nonpharmacologically. A total of 2867 hypoglycemia-related admission occurred, the incident rate was 9.33 per 1000 person. The risk was higher among female patients and older patients with several comorbidities, including cardiovascular disease, cerebrovascular disease, chronic liver disease, chronic kidney disease, dementia, and malignancies. Treatment modalities, including insulin and sulfonylureas, were associated with a high risk of hypoglycemia. After adjustments for age, sex, the different comorbidities, and the treatment modalities, we determined that chronic kidney disease and dementia were associated with a high risk of hypoglycemia-related hospitalization (odds ratio [OR]?=?2.52 and OR?=?1.93, respectively). Furthermore, patients with chronic kidney disease or dementia who were treated with sulfonylureas and insulin had very high risks of hypoglycemia, and the incident rate was 66.6 and 63.75 per 1000 person, respectively.In conclusion, the presence of comorbidities, especially chronic kidney disease and dementia, increased the risk of hypoglycemia-associated hospitalization within this population of older patients with diabetes. The impact of the treatment modality, for example, insulin or sulfonylureas, on hypoglycemia was much greater among these patients.

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Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach.

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Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach.

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