Clinical research study
Hospital Costs of Acute Pulmonary Embolism

https://doi.org/10.1016/j.amjmed.2012.07.025Get rights and content

Abstract

Objective

Pulmonary embolism places a heavy economic burden on health care systems, but the components of hospital cost have not been elucidated. We evaluated hospitalized patients with the primary diagnosis of pulmonary embolism. Our goal was to determine the total and component costs associated with their hospital care.

Methods

We included patients hospitalized at Brigham and Women's Hospital from September 2003 to May 2010. Patient demographics, characteristics, comorbidities, interventions, and treatments were obtained from the electronic medical record. Costs were obtained using the hospital's accounting software and categorized into the areas providing direct patient supplies or care.

Results

We identified 991 hospitalized patients with acute pulmonary embolism. In-hospital mortality was 4.2%, and 90-day mortality after hospital discharge was 13.8%. The median length of hospital stay was 3 days, and the mean length of hospital stay was 4 days. The mean total hospitalization cost per patient was $8764. Nursing costs, which included room and board, were $5102. Pharmacy ($966) and radiology ($963) costs were similar. Pharmacy costs ($966) were dominated by the use of low-molecular-weight heparin ($232). Radiology costs ($963) were dominated by the use of diagnostic imaging examinations ($672). During the observation period, an average of 160 patients with pulmonary embolism were admitted each year, requiring an annual hospital expense ranging from $884,814 to $1,866,489.

Conclusions

Pulmonary embolism has a high case fatality rate and remains an expensive illness to diagnose and treat. Nursing costs comprise the largest component of costs.

Section snippets

Materials and Methods

We enrolled consecutive hospitalized patients with pulmonary embolism at Brigham and Women's Hospital during the period from September 2003 to May 2010. By using our hospital medical records computer system, we identified patients using diagnostic-related group codes 175 (pulmonary embolism with major complication/comorbidity) and 176 (pulmonary embolism without major complication/comorbidity). Patients were included if there was a clinical diagnosis of pulmonary embolism or a diagnosis

Results

Overall, we identified 991 hospitalized patients with pulmonary embolism as the primary diagnosis. Baseline characteristics and comorbidities are shown in Table 1. The median age was 61 years, with 194 patients (19.6%) aged more than 75 years. There were more women (568, 57.3%) than men (423, 42.7%). The median length of hospital stay was 3 days (interquartile range, 2-5 days). Approximately half of our patients had active cancer (450, 45.4%), approximately one third were obese (315, 31.8%),

Discussion

Pulmonary embolism continues to have a high case fatality rate of 4.2% in-hospital and 13.8% at 90 days after hospital discharge. The average cost to treat each patient with pulmonary embolism was $8763. Nursing costs, followed by pharmacy and radiology, comprised the greatest component of the expense. In addition, we found an increasing trend in the prevalence of pulmonary embolism from 2004 to 2008, followed by a decline in 2009. Others have reported a steady increase in the number of

Conclusions

Our study indicates that pulmonary embolism continues to impose a high case fatality rate and a heavy economic burden. Future studies should investigate whether risk stratification and focused prevention efforts and treatment strategies to reduce length of hospital stay or to transition when appropriate to entirely outpatient management will reduce costs.

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  • Cited by (0)

    Funding: This study was supported in part by Eisai, Inc.

    Conflict of Interest: Dr Goldhaber receives research funds from Eisai, Inc, EKOS Corporation, and Sanofi-Aventis and is a consultant for Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Inc, Merck, Portola, Pfizer, and Sanofi-Aventis. Dr Piazza is supported by a Research Career Development Award (K12 HL083786) from the National Heart, Lung, and Blood Institute. All other authors have no conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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