In-Hospital Resource Use and Medical Costs in the Last Year of Life by Mode of Death (from the HF-ACTION Randomized Controlled Trial) - 26/09/12
Résumé |
Patterns of medical resource use near the end of life may differ across modes of death. The aim of this study was to characterize patterns of inpatient resource use and direct costs for patients with heart failure (HF) who died of sudden cardiac death (SCD), HF, other cardiovascular causes, or noncardiovascular causes during the last year of life. Data were from a randomized trial of exercise training in patients with HF. Mode of death was adjudicated by an end point committee. Generalized estimating equations were used to compare hospitalizations, inpatient days, and inpatient costs incurred during the final year of life in patients who died of different causes, adjusting for clinical and treatment characteristics. Of 2,331 patients enrolled in the trial, 231 died after ≥1 year of follow-up with an adjudicated mode of death, including 72 of SCD, 80 of HF, 34 of other cardiovascular causes, and 45 of noncardiovascular causes. Patients who died of SCD were younger, had less severe HF, and incurred fewer hospitalizations, fewer inpatient days, and lower inpatient costs than patients who died of other causes. After adjustment for patient characteristics, inpatient resource use varied by 2 to 4 times across modes of death, suggesting that cost-effectiveness analyses of interventions that reduce mortality from SCD compared to other causes should incorporate mode-specific end-of-life costs. In conclusion, resource use and associated medical costs in the last year of life differed markedly in patients with HF who experienced SCD and patients who died of other causes.
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This study was supported by Grant 5R01NR011873-02 from the National Institute of Nursing Research, Bethesda, Maryland. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was funded by Grants 5U01HL063747, 5U01HL066461, 5U01HL068973, 5U01HL066501, 5U01HL066482, 5U01HL064250, 5U01HL066494, 5U01HL064257, 5U01HL066497, 5U01HL068980, 5U01HL064265, 5U01HL066491, and 5U01HL064264 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and Grants R37AG018915 and P60AG010484 from the National Institute on Aging, Bethesda, Maryland. Damon M. Seils, MA, Duke University, assisted with manuscript preparation. Mr. Seils did not receive compensation for his assistance apart from his employment at the institution at which the study was conducted. |
Vol 110 - N° 8
P. 1150-1155 - octobre 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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