One third of hospital costs for atherothrombotic disease are attributable to readmissions: a linked data analysis

BMC Health Services Research

Tom G Briffa¹  Matthew Knuiman¹  Elizabeth A Geelhoed¹  Emily R Atkins¹ 

[1] School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, Australia

关键词: Western Australia;    Linked data;    Stroke;    Peripheral vascular disease;    Hospital;    Coronary heart disease;    Cardiovascular disease;   

Others  :  1126771
DOI  :  10.1186/1472-6963-14-338

 received in 2014-03-05, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Background

Cardiovascular disease is the most frequent cause of death in Australia, with an associated cost burden of 11% of Australian annual health expenditure of which 40% is for hospital admissions. We investigated health outcomes and the components of hospital expenditure in the two years after an atherothrombotic disease admission to a tertiary hospital in an Australian setting.

Methods

Using data linkage we analysed two years of hospitalisation data and death records of all men and women aged 35–84 years with an admission to a Western Australian tertiary hospital for atherothrombotic disease in 2007. Costs were identified by matching the Australian refined diagnostic related group on the admission records to the published schedules of public and private hospital costs for the period of interest, and converted to 2013 Australian dollars.

Results

Of 6172 patients studied (74% coronary, 20% cerebrovascular, 6% peripheral), 783 (13%) died during follow-up and 174 of these were in hospital case-fatalities at index. Thirty-two percent of patients (n = 1965) accounted for 3172 readmissions to hospital with one in three having multiple hospitalisations. The hazard ratio of atherothrombotic disease readmission was 1.45 (95% CI 1.27, 1.66) in those with more than one vascular territory affected compared to those with only one territory affected after controlling for age, sex, comorbidity, admission type, procedures, and episode length of stay. The total index plus 2-year admission cost for atherothrombotic disease was calculated at $101 million; $71 million for index, and $30 million for readmissions.

Conclusions

Among patients hospitalised with atherothrombotic disease, the cost of related rehospitalisations within 24 months is almost a third of the total. Much of the readmission costs fell within the first year. Whether readmissions and cost associated with atherothrombotic disease can be lowered through secondary prevention measures requires further investigation.

【 授权许可】

   
2014 Atkins et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Cardiovascular Disease: Australian Facts 2011 [Internet]. 2011. [Volume AIHW cat. no. CVD 53.] http://www.aihw.gov.au/publication-detail/?id=10737418510 webcite
• [2]Australian Institute of Health and Welfare: Health expenditure Australia 2010–11. Canberra: AIHW; 2012. [Volume Cat. no. HWE 56]
• [3]Drouet L: Atherothrombosis as a systemic disease. Cerebrovasc Dis 2002, 13(suppl 1):1-6.
• [4]Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wasserthiel-Smoller S, Turan TN, Wentworth D, on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research: Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. Stroke 2011, 42(1):227-276.
• [5]Norman PE, Eikelboom JW, Hankey GJ: Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications. Med J Aust 2004, 181(3):150-154.
• [6]Smith S Jr, Allen J, Blair S, Bonow R, Brass L, Fonarow G, Grundy S, Hiratzka L, Jones D, Krumholz H, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA: AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 2006, 113(19):2363-2372.
• [7]Naderi SH, Bestwick JP, Wald DS: Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med 2012, 125(9):882-887. e881
• [8]Ademi Z, Liew D, Chew D, Conner G, Shiel L, Nelson M, Soman A, Steg G, Bhatt DL, Reid C: Drug treatment and cost of cardiovascular disease in Australia. Cardiovasc Ther 2009, 27(3):164-172.
• [9]Gunnell AS, Einarsdóttir K, Sanfilippo F, Liew D, Holman CDAJ, Briffa T: Improved long-term survival in patients on combination therapies following an incident acute myocardial infarction: a longitudinal population-based study. Heart 2013, 99(18):1353-1358.
• [10]Levy E, Gabriel S, Dinet J: The comparative medical costs of atherothrombotic disease in European countries. Pharmacoeconomics 2003, 21(9):651-659.
• [11]Maniadakis N, Kourlaba G, Cokkinos D, Angeli A, Kyriopoulos J: The economic burden of atherothrombosis in Greece: results from the THESIS study. Eur J Health Econ 2013, 14(4):655-665.
• [12]Brüggenjürgen B, Rupprecht HJ, Willich SN, Spannagl M, Ehlken B, Smala A, Berger K, Diener HC: Cost of atherothrombotic diseases—myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease—in Germany. J Public Health 2005, 13(4):216-224.
• [13]Atkins E, Geelhoed E, Nedkoff L, Briffa T: Disparities in equity and access for hospitalised atherothrombotic disease. Aust Health Rev 2013, 37(4):488-494.
• [14]Nedkoff L, Briffa TG, Knuiman M, Hung J, Norman PE, Hankey GJ, Thompson PL, Geelhoed E, Sanfilippo FM, Hickling S, Bremner A, Hobbs M: Temporal trends in the incidence and recurrence of hospitalised atherothrombotic disease in an Australian population, 2000–07: data linkage study. Heart 2012, 98(19):1449-1456.
• [15]Data Linkage Western Australia [Internet] [http://www.datalinkage-wa.org.au/ webcite]
• [16]Holman CDJ, Bass AJ, Rouse IL, Hobbs MST: Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health 1999, 23(5):453-459.
• [17]Public Sector Estimated Cost Weights Round 12 AR-DRG v5.1 [http://www.health.gov.au/internet/main/publishing.nsf/Content/Round_12-cost-reports webcite]
• [18]Private Sector Estimated Cost Weights Round 12 AR-DRG v5.1 [http://www.health.gov.au/internet/main/publishing.nsf/Content/Round_12-cost-reports webcite]
• [19]Public Sector - Estimated Round 14 (2009–10) AR-DRG 6.0x Cost Report [http://www.health.gov.au/internet/main/publishing.nsf/Content/Round_13-cost-reports webcite]
• [20]ARIA (Accessibility/Remoteness Index of Australia) [http://www.adelaide.edu.au/apmrc/research/projects/category/aria.html webcite]
• [21]Australian Bureau of Statistics: Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA), 2006. 2008. [Volume ABS cat. no. 2039.0.] http://www.abs.gov.au/ausstats/abs@.nsf/mf/2039.0 webcite
• [22]Briffa TG, Nedkoff LJ, Knuiman MW, Hankey GJ, Norman PE, Hung J, Thompson PL, Hickling S, Bremner A, Sanfilippo FM: Cross vascular risk for first and recurrent hospitalised atherothrombosis determined retrospectively from linked data. BMJ open 2013, 3(11):e003813. doi:10.1136/bmjopen-2013-0038135
• [23]Hankey GJ, Norman PE, Eikelboom JW: Medical treatment of peripheral arterial disease. JAMA 2006, 295(5):547-553.
• [24]Steg P, Bhatt DL, Wilson PF, D’Agostino R Sr, Ohman EM, Röther J, Liau CS, Hirsch AT, Mas JL, Ikeda Y, Pencina MJ, Goto S, for the REACH Registry Investigators: One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007, 297(11):1197-1206.
• [25]Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JNE, Bull LM, Welch SJV, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z, for the Oxford Vascular Study: Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005, 366(9499):1773-1783.
• [26]Ademi Z, Liew D, Hollingsworth B, Wolfe R, Steg GP, Bhatt DL, Reid CM: The economic implications of treating atherothrombotic disease in Australia, from the government perspective. Clin Ther 2010, 32(1):119-132.