Diffuse Lung Disease: Care of the Patient with IPF |

Cost of Hospitalization Among Patients With Idiopathic Pulmonary Fibrosis: Patterns and Predictors FREE TO VIEW

Roozbeh Sharif, MD; Aline Zouk, MD; Tejaswini Kulkarni, MD; Pilar Acosta, MD; Steve Duncan, MS; Tracy Luckhardt, MD; Victor Thannickal, MD; Joao Alberto de Andrade, MD
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University of Alabama at Birmingham, Birmingham, AL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):469A. doi:10.1016/j.chest.2016.08.483
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SESSION TITLE: Care of the Patient with IPF

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 08:45 AM - 10:00 AM

PURPOSE: Chronic diseases account for $3 of every $4 spent on healthcare and cause 7 out of every 10 deaths. Among these, chronic lung diseases are the 3rd most expensive with $174 billion annually. No study examined financial burden of interstitial lung disease (ILD) and, in particular, idiopathic pulmonary fibrosis (IPF), a progressive and fatal form of ILD. We aimed to examine cost of hospitalization among ILD patients with connective tissue disease (CTD-ILD) and IPF compared to those with chronic obstructive pulmonary disease (COPD) and to identify correlates of cost of hospitalization among IPF patients.

METHODS: Out of 21,046 patients admitted to a tertiary academic medical center with chronic lung conditions between July 2010 and June 2015, all admissions with a primary discharge diagnosis of acute exacerbation of COPD (International Statistical Classification of Disease [ICD-9] code of 491.21), rheumatoid lung disease, systemic sclerosis interstitial lung disease, and other CTD-ILDs (ICD9 of 714.81, 517.2, and 517.8, respectively), and IPF (ICD9 of 516.31) were included. We categorized the patients into three groups of COPD, CTD-ILD, and IPF groups. Primary outcome was total cost of hospitalization (cost), defined as sum up of fixed direct, indirect and variable costs. Secondary outcomes were daily cost (total cost per day), length of stay and ICU stay. Next, using multiple linear regression we examined how demographics, clinical, and type of provider correlate with cost among patients with IPF.

RESULTS: Of 1994 admissions, 1,484 (74.4%) had acute exacerbations of COPD; 382 (19.2%) had CTD-ILD, and 128 patients (6.4%) were hospitalized for IPF. Total cost was substantially higher among those with CTD-ILD and IPF, compared to those with COPD ($13,227 and $12,850 vs. $5631, p<0.001). The same pattern was noted for cost per day. There was no significant difference in total cost of CTD-ILD and IPF, however cost per day was lower among patients with CTD-ILD compared to those with IPF (p<0.001), after adjustment for demographics and provider type. Length of stay and ICU days were substantially higher among those with CTD-ILD and IPF compared to those with COPD; with no significant difference between CTD-ILD and IPF. Multivariable analysis showed among patients with IPF, presence of typical usual interstitial pneumonia pattern on HRCT correlated with cost of hospitalization (regression coefficient [β]: 9333.67; p: 0.002), hospitalization duration (β: 5.88; p<0.001) and ICU stay (β: 1.53; p: 0.040), after adjustment for demographics, forced vital capacity percent predicted value, and comorbid conditions.

CONCLUSIONS: Hospitalizations for chronic lung disease are costly. The cost of hospitalizations among patients with ILD is substantially higher than other chronic lung disease such as COPD. Among ILD patients, those with IPF pose higher financial burden compared to others. Disease severity is the major contributor to cost and utilization of healthcare resources.

CLINICAL IMPLICATIONS: Hospitalization of patients with ILD poses significant financial burden. Further studies are warranted to investigate the predictors of cost and outcome of these hospitalizations to identify potential modifiable factors.

DISCLOSURE: The following authors have nothing to disclose: Roozbeh Sharif, Aline Zouk, Tejaswini Kulkarni, Pilar Acosta, Steve Duncan, Tracy Luckhardt, Victor Thannickal, Joao Alberto de Andrade

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