Intracerebral hemorrhage correlates with ‘significant’ health care costs

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Fernando does not report any relevant financial information. Please see the full study for all relevant financial information from the other authors.

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The total cost for one year related to intracerebral bleeding exceeded $ 120 million per year, according to results of a retrospective cohort study of adult patients in Ontario, Canada, published in Neurology.

“While intracerebral haemorrhage morbidity and mortality have been extensively studied, less is known about patient and health care costs and resource use,” the researchers write. “Understanding health costs, especially in relation to patient outcomes, is a necessary step in optimizing resource use and health care. Patients with intracranial haemorrhage (including subarachnoid haemorrhage and traumatic haemorrhage) are associated with significant hospital costs, often due to a long stay in the intensive care unit. “

Reference: Fernando SM, et al. Neurology. 2021; doi: 10.1212 / WNL.000000000012355.

Shannon M. Fernando, MD, MSc, resident physician in the Medical and Emergency Medicine departments of the University of Ottawa, and colleagues wanted to determine the resource consumption of patients with intracerebral hemorrhage and the associated costs in the short and long term. They also looked at the relationship between oral anticoagulation and health care costs.

Researchers collected data on outcomes across health administration databases and used generalized linear models to determine factors related to total cost. They limited their analysis of oral anticoagulation to patients aged 66 years and under. The primary endpoint was total direct health costs for one year in US dollars in 2020.

The study included 16,248 people with intracerebral haemorrhage (mean age 71.2 years; 52.3% men). In this group, the 1-year mortality rate was 46% and 24.2% of the patients required mechanical ventilation according to the study results. The median length of stay in the hospital was 9 days (interquartile range [IQR], 4-20 days). According to the study results, only 2,290 patients (14.1%) were discharged home independently; 7,076 patients (34.1%) were discharged into inpatient long-term rehabilitation centers and 876 patients (4.2%) into long-term care.

Fernando and colleagues reported an average 1-year total cost of intracerebral bleeding of $ 26,886 (IQR, $ 9,641 $ 62,907). The cost for patients who survived to discharge was much higher ($ 44,969; IQR: $ 20,264-$ 82,414 compared to the cost for patients who died in hospital ($ 7,268; IQR: $ 4,031 $ 14,966). This Results were statistically significant (P <0.001), according to the researchers. Of those patients who survived to discharge, the study found that post-discharge costs accounted for more than half ($ 26,250) of the total cost of $ 44,969 per patient .

In their analysis of the use of oral anticoagulants, Fernando and colleagues found that these agents correlated with higher total costs for one year (cost ratio 1.06; 95% CI 1.01-1.11).

The researchers reported an average inpatient cost per patient of $ 10,120 (IQR, $ 5,356 to $ 23,940). Among patients using these services, the median cost per patient was $ 23,702 (IQR, $ 6,476-55,297) for continuous complex outpatient care, $ 13,835 (IQR, $ 2,099-26,811) for long-term care, $ 23,969 ( IQR, $ 17,096-31,951) for rehabilitation and $ 1,294 (IQR, $ 344- $ 4,868) for home care, the study found.

Fernando and colleagues also looked at predictors for 1-year costs. They found that the burden of comorbidity correlated with increased costs, “suggesting that comorbid patients are likely to have increased need for care, especially if they survive to discharge”. Previous intracerebral bleeding did not correlate with higher costs for survivors, but previous ischemic stroke, the researchers found.

“Our work provides novel data from an entire population on the financial burden of [intracerebral hemorrhage], which has a particular impact on healthcare management and highlights the cost of this devastating condition at the system level, ”wrote Fernando and colleagues.

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source https://dailyhealthynews.ca/intracerebral-hemorrhage-correlates-with-significant-health-care-costs/