PURPOSE: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive lung fibrosis that leads to respiratory failure within 3-5 years of diagnosis in patients with advanced disease. Data regarding hospital admissions, in-hospital mortality, length of stay (LOS), and costs associated with IPF are scarce. To bridge this gap in knowledge, we analyzed data available through the Healthcare Cost and Utilization Project (HCUP) Database.
METHODS: The HCUPnet database provides access to national health statistics in the U.S. from 1993-2008. Using this database we analyzed data related to ICD-9-CM codes for postinflammatory pulmonary fibrosis (PPF, 515) and idiopathic fibrosing alveolitis (IFA, 516.3).
RESULTS: We found a steady increase in the number of hospital discharges of patients with PPF reaching close to 30,000/year in 2008. Discharges where PPF was not the principal diagnosis also increased from 150,000 in 1993 to over 250,000 in 2008. In contrast, in-hospital mortality decreased from 9% to 6.95% and LOS decreased from 8 to 6 days. However, hospitalization charges during this time increased from just over $15,000 in 1993 to over $40,000 in 2008. Discharges for IFA declined, reaching 3,513/year in 2008; the most significant decrease occurred in 2003-2004. In-hospital mortality for patients with IFA showed a downward trend from 16.89% to 14.92% while LOS remained between 7.2 and 9.7 days. Hospitalization costs increased 3.8 fold from 1993-2008 and doubled between 2007 and 2008 to $81,000.
CONCLUSIONS: PPF discharges increased since 1993, while LOS and in-hospital mortality decreased. IFA discharges decreased, especially between 2003 and 2004; the reasons might be multifactorial. Despite decreases in LOS and in-hospital mortality, hospitalization costs increased greatly.
CLINICAL IMPLICATIONS: Resources will be needed to accommodate the increased hospitalization rate of patients with pulmonary fibrosis and the increased costs associated. The decrease observed in LOS and in-hospital mortality might be related to the treatment of related conditions since there are no FDA-approved anti-fibrotic drugs found to be effective.
DISCLOSURE: Jesse Roman: Grant monies (from industry related sources): Funded for research trials (Immuneworks). No money directly received., Consultant fee, speaker bureau, advisory committee, etc.: Chair of a data monitoring board (DMB) for Celgene. Not a paid position., Grant monies (from sources other than industry): Veteran Affairs clinic funding for pulmonary fibrosis research., Grant monies (from sources other than industry): NIH funding for pulmonary fibrosis research.
The following authors have nothing to disclose: Daniel Fioret, David Mannino
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