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The financial impact of heparin-induced thrombocytopenia
Maureen A Smythe1, John M Koerber1, Maureen Fitzgerald2
1Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI.
Insights
Heparin-induced thrombocytopenia (HIT) significantly impacts hospital finances, costing over $14,000 per patient and increasing length of stay. Annual losses can reach $1 million, especially in high-occupancy facilities.
Area of Science:
- Medical Economics
- Pharmacovigilance
- Hospital Administration
Background:
- Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction with significant morbidity, mortality, and presumed institutional financial burden.
- Understanding the economic consequences of HIT is crucial for healthcare management and resource allocation.
Purpose of the Study:
- To quantify the financial impact of heparin-induced thrombocytopenia (HIT) on healthcare institutions.
- To assess the relationship between HIT, length of stay, and patient outcomes.
Main Methods:
- A case-control study design was utilized, comparing newly diagnosed HIT patients with matched control subjects.
- Financial data, including total cost and reimbursement, were extracted from hospital databases.
- Key financial metrics such as profit/loss and the 'backfill effect' were calculated, alongside length of stay and mortality.
Main Results:
- HIT patients incurred an average financial loss of $14,387, with an extended length of stay by 14.5 days.
- For Medicare patients, the financial loss per case was $20,170, with a 15.8-day increase in length of stay.
- Mortality rates did not differ significantly between HIT patients and controls, but the 'backfill effect' could exacerbate financial losses in high-occupancy settings.
Conclusions:
- The projected annual financial impact of HIT for an institution with 50 cases is substantial, ranging from $700,000 to $1 million.
- High hospital occupancy rates amplify financial losses due to the 'backfill effect' associated with increased length of stay in HIT patients.
Background:
Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT.
Methods:
A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared.
Results:
Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected.
Conclusion:
For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.
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