Decreased Hospitalizations, Shorter Length of Stay Does Not Reduce GI Cancer-Related Costs

01/23/18

A recent study presented at the 2018 Gastrointestinal Cancers Symposium (January 18-20, 2018; San Francisco, CA) sought to identify the trends in incidence and costs of gastrointestinal cancer-related hospital admissions in the United States.

As recent as 2009, adult patients had 4.7 million cancer-related hospitalizations in the United States. Hospital stays as a result of a cancer diagnosis accounted for $20.1 billion in costs and 6% of adult inpatient hospital costs in that year. A better understanding of gastrointestinal cancer-specific health care utilization is needed.

Aileen Deng, MD, and Atrayee Basu Mallick, MD, of the Thomas Jefferson University Hospital (Philadelphia, PA), evaluated gastrointestinal cancer incidence and costs resulting from hospital admission from 1997 to 2014. Researchers reviewed the National Inpatient Sample Database to identify all patients with principle discharge diagnoses of esophageal, stomach, colon, rectum and anus, liver and intrahepatic bile duct, and pancreas cancer.

Temporal trends in the number of hospital admissions, length of stay, hospitalization cost, and mortality rates were gathered through HCUPnet.

Results of the evaluation showed that gastrointestinal cancer-related hospital admissions decreased from 1997 to 2014 (230,537 vs 221,220, respectively). While the number of hospital admissions decreased for esophageal (12,157 vs 11,885), stomach (23,528 vs 21,800), colon (110,939 vs 90,135), rectum and anus (43,807 vs 40,160), incidence has increased for liver and intrahepatic bile duct (11,243 vs 21,775) and pancreas cancer (28,862 vs 35,465).

Additionally, researchers reported that while the mean length of stay decreased from 9.6 days in 1997 to 7.6 days in 2014, the mean hospital charges per patient—after adjusting for inflation—increased 127% ($34,747 vs $78,742, respectively). Among the highest increase in mean hospital charges per patient were liver and intrahepatic bile duct ($27,128 vs $74,619), rectum and anus ($32,566 vs $90,789), and pancreas cancer diagnoses ($33,562 vs $75,981).

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Dr Deng and Dr Mallick concluded that despite the decrease in gastrointestinal cancer-related hospital admissions and mean length of hospital stay from 1998 through 2014, costs of hospitalizations have increased significantly, particularly in liver and intrahepatic bile duct, rectum and anus, and pancreas cancer. This conclusion led them to the finding that shorter length of stay alone has not reduced costs of hospitalizations in gastrointestinal cancers. “There remains a growing need to understand health care costs and to develop effective value-based interventions in gastrointestinal cancer-related hospital admissions,” they wrote.—Zachary Bessette