Exploratory analysis of the potential for advanced diagnostic testing to reduce healthcare expenditures of patients hospitalized with meningitis or encephalitis


Autoři: Brent D. Fulton aff001;  David G. Proudman aff001;  Hannah A. Sample aff002;  Jeffrey M. Gelfand aff003;  Charles Y. Chiu aff004;  Joseph L. DeRisi aff002;  Michael R. Wilson aff003
Působiště autorů: School of Public Health, University of California, Berkeley, Berkeley, California, United States of America aff001;  Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, California, United States of America aff002;  Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, United States of America aff003;  Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States of America aff004;  Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America aff005;  UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, California, United States of America aff006;  Chan Zuckerberg Biohub, San Francisco, California, United States of America aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226895

Souhrn

Objective

To estimate healthcare expenditures that could be impacted by advanced diagnostic testing for patients hospitalized with meningitis or encephalitis

Methods

Patients hospitalized with meningitis (N = 23,933) or encephalitis (N = 7,858) in the U.S. were identified in the 2010–2014 Truven Health MarketScan Commercial Claims and Encounters Database using ICD-9-CM diagnostic codes. The database included an average of 40.8 million commercially insured enrollees under age 65 per year. Clinical, demographic and healthcare utilization criteria were used to identify patient subgroups early in their episode who were at risk to have high inpatient expenditures. Healthcare expenditures of patients within each subgroup were bifurcated: those expenditures that remained five days after the patient could be classified into the subgroup versus those that had occurred previously.

Results

The hospitalization episode rate per 100,000 enrollee-years for meningitis was 13.0 (95% CI: 12.9–13.2) and for encephalitis was 4.3 (95% CI: 4.2–4.4), with mean inpatient expenditures of $36,891 (SD = $92,636) and $60,181 (SD = $130,276), respectively. If advanced diagnostic testing had been administered on the day that a patient could be classified into a subgroup, then a test with a five-day turnaround time could impact the following mean inpatient expenditures that remained by subgroup for patients with meningitis or encephalitis, respectively: had a neurosurgical procedure ($83,337 and $56,020), had an ICU stay ($34,221 and $46,051), had HIV-1 infection or a previous organ transplant ($37,702 and $62,222), were age <1 year ($35,371 and $52,812), or had a hospital length of stay >2 days ($18,325 and $30,244).

Discussion

Inpatient expenditures for patients hospitalized with meningitis or encephalitis were substantial and varied widely. Patient subgroups who had high healthcare expenditures could be identified early in their stay, raising the potential for advanced diagnostic testing to lower these expenditures.

Klíčová slova:

Diagnostic medicine – Encephalitis – Health economics – HIV-1 – Hospitals – Inpatients – Intensive care units – Meningitis


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