Clinical InvestigationsOutcomes, Health Policy and Managed CareFactors associated with variations in hospital expenditures for acute heart failure in the United States
Section snippets
Data sources
The NIS is sponsored by the Agency for Healthcare Research and Quality through HCUP and is the largest all-payer inpatient database available publically in the United States containing discharge data from about 1,000 hospitals across 46 states in 2011. The database includes charge information regardless of payer or insurance status, as well as clinical and resource use information included in a typical discharge abstract. Approximately 8 million hospitalizations per year are selected from a 20%
Results
The NIS data set for 2011 includes 8 million discharges. There were 217,449 discharges with a primary diagnosis of AHF for patients >18 years of age. After weighting, we estimated that there were approximately 1 million AHF discharges in the United States in 2011 (Figure 1). The mean national cost estimates for AHF were $10,775 per AHF hospitalization episode, which was about one-third the amount of mean hospital charges. Inpatient costs for 2011 AHF hospitalizations were right-skewed, with a
Discussion
Hospital expenditures varied substantially among patients in the United States hospitalized with AHF in 2011, with highest-cost AHF inpatient stays having approximately 9-fold higher expenditures and 5 times longer length of stay compared with lowest-cost stays. Substantial differences were found in patient and hospital characteristics, procedures, and in-hospital outcomes among AHF hospitalizations with highest versus lowest costs. In-hospital mortality was higher for highest-cost compared
Limitations
The NIS data set unit is based on hospitalizations and lacks individual patient identifiers; consequently, readmissions are not identified. Rehospitalization rates are estimated to approach 30% for HF.12 We are therefore not able to distinguish variation in costs between AHF hospitalizations and AHF rehospitalizations. We only included hospitalizations with a primary discharge diagnosis for AHF and not secondary diagnoses, and the degree of variation in expenditures and associated factors may
Conclusions
This study provides insights into the high cost and variation in hospital expenditures among AHF hospitalizations in the United States and identifies factors associated with higher and lower expenditures. Select demographic factors and comorbidities are independently associated with variations in hospital expenditures, as are certain in-hospital procedures. Expenditures also vary by hospital characteristics, including geographic location. These findings may assist in further understanding
Author disclosures
Boback Ziaeian: no relationships to disclose.
Puza P. Sharma: Novartis Pharmaceuticals Corporation employee and stockholder.
Tzy-Chyi Yu: Novartis Pharmaceuticals Corporation employee and stockholder.
Katherine Waltman Johnson: Novartis Pharmaceuticals Corporation employee and stockholder (significant).
Gregg C. Fonarow: Research AHRQ (significant), NHLBI (significant); Consultant Bayer (modest), Gambro (modest), Medtronic (modest), Novartis (significant), Boston Scientific (modest), Medicines
Acknowledgements
The authors developed the manuscript, and all authors significantly edited the first draft for intellectual content. All authors approved the final manuscript that is submitted for publication.
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2021, International Journal of CardiologyCitation Excerpt :Hospitalization costs have also been previously investigated in the National Inpatient Survey. Ziaeian at al [7] similarly identified the role of key comorbidities in a cohort of heart failure patients hospitalized in 2011, but did not examine the costs associated with 30 day readmissions. In the current study, we report the contribution of cardiac and non-cardiac comorbidities to the costs of inpatient care among a large sample of patients hospitalized with a primary diagnosis of heart failure.
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Financial support: Novartis Pharmaceuticals (East Hanover, NJ) provided funding and review of manuscript prior to submission.