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The cost of hospitalization in Crohn's disease
R D Cohen1, L R Larson, J M Roth
1University of Chicago, Department of Medicine, Illinois, USA.
Insights
Hospitalizations for Crohn's disease are often surgical, incurring significant costs. Reducing surgical interventions could substantially lower overall inpatient expenses for Crohn's disease management.
Area of Science:
- Gastroenterology
- Health Economics
- Hospital Management
Background:
- Crohn's disease is a chronic inflammatory bowel disease requiring significant healthcare resources.
- Understanding hospitalization patterns and costs is crucial for effective resource allocation and patient management.
Purpose of the Study:
- To analyze the demographics, resource utilization, and associated costs of hospitalizations for Crohn's disease patients.
- To identify key drivers of healthcare expenditure in inpatient Crohn's disease care.
Main Methods:
- Retrospective analysis of 175 hospitalizations for Crohn's disease between July 1, 1996, and June 30, 1997.
- Data collected from a computerized database included patient demographics, procedures, length of stay, costs, charges, and reimbursements.
Main Results:
- The average patient age was 36.5 years, with 61% being female and 82% Caucasian.
- Surgery was performed in 57% of hospitalizations, with an average length of stay of 9.6 days and costs of $14,409.
- Total hospitalization costs averaged $12,528 (excluding physician fees), with surgery accounting for 39.6% of total costs.
Conclusions:
- Surgical interventions represent a major component of Crohn's disease hospitalizations, driving significant costs and charges.
- Strategies aimed at reducing the incidence of surgical hospitalizations could lead to substantial reductions in overall inpatient healthcare expenditures for Crohn's disease.
Objective:
The aim of this study was to evaluate the demographics, resource use, and costs associated with hospitalization of Crohn's disease patients.
Methods:
All patients hospitalized at our institution from 7/1/96 to 6/30/97 with a primary diagnosis of "Crohn's Disease" were analyzed using a computerized database. Data are presented "per hospitalization."
Results:
A total of 175 hospitalizations (147 patients) were identified. Mean patient age was 36.5 yr; 61% were female; 82% Caucasian. Payer mix was most commonly contracted (57%), commercial (21%), or Medicare (13%). 57% of hospitalizations had a primary surgical procedure; the remainder were medical. Average length of stay was 8.7 days (surgical, 9.6 days; medical, 7.5 days). The average cost of hospitalization, excluding physician fees, was $12,528 (surgical, $14,409; medical, $10,020), whereas average charges were $35,378 (surgical, $46,354; medical, $20,744), including physician fees, which averaged $7,249 (surgical, $11,217; medical, $1,959). Mean reimbursements were $21,968 (surgical, $28,946; medical, $12,666) with average weighted reimbursement rates of 60.17% of hospital charges, 69.57% of physician fees. The distribution of costs across subcategories was: Surgery (39.6%), Pharmacy (18.6%), Laboratory (3.8%), Radiology (2.1%), Pathology (0.8%), Endoscopy (0.3%), and Other Hospital Costs (34.9%). Of the hospitalizations, 87% included treatment with steroids, 23% with immunomodulators, and 14% with aminosalicylates; 27% included the administration of total parenteral nutrition, which accounted for 63% of the total pharmacy costs.
Conclusions:
Surgery accounts for the majority of hospitalizations, nearly 40% of their total costs, and 75% of overall charges and reimbursements. Therapy that decreases the number of surgical hospitalizations should substantially reduce inpatient Crohn's disease costs, as well as overall costs.