Economic impact of self-administered subcutaneous versus clinic-administered intravenous immunoglobulin G therapy in Alberta, Canada: a population-based cohort study.

BACKGROUND: Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations. METHODS: A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed. RESULTS: Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg. CONCLUSIONS: Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. Within this type of health system, switching to self-administered SCIg has the potential to reduce overall health care costs, lessen nursing burden, and may increase clinic-based capacity for others.

The Healthcare Cost Burden in Adults with High Risk for Cardiovascular Disease.

OBJECTIVE: We calculated the short- and long-term care resource use and costs in adults with high-risk conditions for cardiovascular disease (HRCVD) as defined by the Canadian Cardiovascular Society dyslipidemia guidelines. METHODS: We linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between fiscal year (FY) 2012 and FY2016. The first HRCVD event was the index event. Patients were categorized into (1) primary prevention patients and (2) secondary prevention patients at the index event and were followed until death, they moved out of the province, or they were censored at March 2018. We calculated the resource use and costs for each of the 5 years after the index event. RESULTS: The study included 459,739 HRCVD patients (13,947 [3%] were secondary prevention patients). The secondary prevention patients were older (median age 61 years vs. 55 years; p < 0.001), and there were fewer females in this group (30.4% vs. 51.3%; p < 0.001). The total healthcare costs in the first year decreased over time (FY2012: 1.16 billion Canadian dollars (CA$); FY2016: CA$1.05 billion; p < 0.001). An HRCVD patient incurred CA$12,068, CA$5626, and CA$4655 during the first, second, and fifth year, respectively (p for trend < 0.001). During the first year, healthcare costs per secondary prevention patient (CA$36,641) were triple that for a primary prevention patient (CA$11,299; p < 0.001), primarily due to higher hospitalization costs in secondary prevention patients (CA$26,896 vs. CA$6051; p < 0.001). CONCLUSIONS: The healthcare costs for HRCVD patients were substantial but decreased over time. The costs were highest in the year following the index event and decreased thereafter. Secondary prevention patients incurred higher costs than the primary prevention patients.

Outcome and Cost of Optimal Control of Dyslipidemia in Adults With High Risk for Cardiovascular Disease.

BACKGROUND: We assessed the impact of optimal dyslipidemia control on mortality and costs in adults at high risk for cardiovascular disease (HRCVD). METHODS: We linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between April 2012 and March 2017. The first HRCVD event was considered the index event. Patients were categorized into (1) optimal control and (2) suboptimal control of dyslipidemia based on biomarkers and lipid-lowering therapy during the year post-index event. We measured the association between optimal dyslipidemia control and mortality and health care costs using difference-in-difference and propensity score-matching methods. RESULTS: The study included 459,739 patients with HRCVD (43,776 [9.5%] optimal patients). The optimal patients were older (median age = 62 vs 55 years; P < 0.001), included fewer female patients (37.7% vs 52%; P < 0.001), and featured a higher proportion of secondary prevention patients (15.7% vs 1.7%; P < 0.001). Compared with suboptimal patients, the optimal patients had lower adjusted mortality (0.7% vs 1.9% at 1-year and 2.9% vs 5.1% at 3-year post-index event; both P < 0.001), and higher adjusted health care costs (CA$3758 and CA$6844 at 1-year and 3-year post-index event, respectively; both P < 0.001). Among the secondary prevention group, the optimal patients had lower adjusted mortality (2.4% and 5% absolute reduction at 1-year and 3-year post-index event, respectively; both P < 0.001) at no additional costs. The results were robust across 5 definitions of optimal dyslipidemia control. CONCLUSIONS: Patients with optimal dyslipidemia control have lower mortality and incur modestly higher costs. However, secondary prevention patients experience lower mortality at no additional costs.

Assessment of Costs of Avoidable Delays in Intensive Care Unit Discharge.

Importance: Delays in transfer for discharge-ready patients from the intensive care unit (ICU) are increasingly described and contribute to strained capacity. Objective: To describe the epidemiological features and health care costs attributable to potentially avoidable delays in ICU discharge in a large integrated health care system. Design, Setting, and Participants: This population-based cohort study was performed in 17 adult ICUs in Alberta, Canada, from June 19, 2012, to December 31, 2016. Participants were patients 15 years or older admitted to a study ICU during the study period. Data were analyzed from October 19, 2018, to May 20, 2020. Exposures: Avoidable time in the ICU, defined as the portion of total ICU patient-days accounted for by avoidable delay in ICU discharge (eg, waiting for a ward bed). Main Outcomes and Measures: The primary outcome was health care costs attributable to avoidable time in the ICU. Secondary outcomes were factors associated with avoidable time, in-hospital mortality, and measures of use of health care resources, including the number of hours in the ICU and the number of days of hospitalization. Multilevel mixed multivariable regression was used to assess associations between avoidable time and outcomes. Results: In total, 28 904 patients (mean [SD] age, 58.3 [16.8] years; 18 030 male [62.4%]) were included. Of these, 19 964 patients (69.1%) had avoidable time during their ICU admission. The median avoidable time per patient was 7.2 (interquartile range, 2.4-27.7) hours. In multivariable analysis, male sex (odds ratio [OR], 0.92; 95% CI, 0.87-0.98), comorbid hemiplegia or paraplegia (OR 1.47; 95% CI, 1.23-1.75), liver disease (OR 1.20; 95% CI, 1.04-1.37), admission Acute Physiology and Chronic Health Evaluation II score (OR, 1.03; 95% CI, 1.02-1.03), surgical status (OR, 0.90; 95% CI, 0.82-0.98), medium community hospital type (OR, 0.12; 95% CI, 0.04-0.32), and admission year (OR, 1.16; 95% CI, 1.13-1.19) were associated with avoidable time. The cumulative avoidable time was 19 373.9 days, with estimated attributable costs of CAD$34 323 522. Avoidable time accounted for 12.8% of total ICU bed-days and 6.4% of total ICU costs. Patients with avoidable time before ICU discharge showed higher unadjusted in-hospital mortality (1115 [5.6%] vs 392 [4.4%]; P < .001); however, in multivariable analysis, avoidable time was associated with reduced in-hospital mortality (adjusted hazard ratio, 0.74; 95% CI, 0.64-0.85). Results were similar in sensitivity analyses. Conclusions and Relevance: In this study, potentially avoidable discharge delay occurred for most patients admitted to ICUs across a large integrated health system and translated into substantial associated health care costs.

The Current and Future Hospitalization Cost Burden of Syncope in Canada.

BACKGROUND: Single-center studies have shown the high costs associated with the hospital evaluation of syncope. National cost estimates for syncope-related hospitalizations are sparse, and none exist in Canada. METHODS: The Canadian Institute for Health Information Discharge Abstract Database was used to identify acute care hospitalizations with a primary diagnosis of syncope between fiscal years (FY) 2004 and 2015 in all provinces and territories (except Quebec). We used multiple linear regression to calculate the trends in prevalence of hospital admissions and generalized linear regression to estimate the costs of a hospitalization. The syncope hospitalization rate and the cost per hospitalization in Quebec were assumed to be the average of the rest of the country. The future hospitalization cost burden of syncope was projected to 2030. RESULTS: There were 128,263 hospitalizations for a primary diagnosis of syncope over the 10-year study period, resulting in a total cost of $619.9 million (Canadian). An estimate of 41,044 syncope hospitalizations occurred in Quebec, costing $198.7 million. The total hospitalization cost of syncope in Canada was estimated at $818.5 million. The annual costs of syncope hospitalizations increased from $66.6 to $68.5 million between FY2004 and FY2015, respectively, and are projected to increase to $87.1 million in 2030. CONCLUSION: Hospitalization costs for syncope in Canada are high and rising. Research is needed to identify opportunities to deliver more efficient and cost-effective care.

CONTEXTE: Des études monocentriques ont mis en lumière les coûts élevés associés à l'évaluation hospitalière d'une syncope. Les estimations nationales du coût des hospitalisations liées aux syncopes sont rares, et il n'en existe aucune au Canada. MÉTHODOLOGIE: La base de données sur les congés des patients de l'Institut canadien d'information sur la santé a été utilisée pour recenser les hospitalisations de courte durée liées à un diagnostic primaire de syncope entre les années financières (AF) 2004 et 2015 dans toutes les provinces et territoires (sauf le Québec). Nous avons eu recours, d'une part, à la régression linéaire multiple pour calculer les tendances de la prévalence d'admissions à l'hôpital et, d'autre part, à la régression linéaire généralisée pour estimer les coûts d'une hospitalisation. Le taux d'hospitalisations liées à une syncope et le coût par hospitalisation au Québec ont été établis hypothétiquement à la moyenne du reste du pays. Le futur fardeau du coût des hospitalisations liées à une syncope a été projeté jusqu'en 2030. RÉSULTATS: Nous avons recensé 128 263 hospitalisations liées à un diagnostic primaire de syncope au cours de la période de 10 ans à l'étude, ce qui se traduit par un coût total de 619,9 M$ (canadiens). Selon une estimation, 41 044 hospitalisations liées à une syncope seraient survenues au Québec, au coût de 198,7 M$. Le coût total des hospitalisations liées à une syncope au Canada a été estimé à 818,5 M$. Les coûts annuels des hospitalisations liées à une syncope ont augmenté, passant de 66,6 à 68,5 M$ entre les AF 2004 et 2015, respectivement, et ils devraient encore augmenter pour atteindre 87,1 M$ en 2030. CONCLUSION: Les coûts des hospitalisations liées à une syncope au Canada sont élevés et en hausse. D'autres travaux de recherche devront être effectués pour cerner les possibilités de prestations de soins plus efficaces et rentables.

The Costs of Industry-Sponsored Drug Trials in Canada.

OBJECTIVE: The objective of this study was to estimate the provincial and nationwide costs of industry-sponsored drug clinical trials (CTs) in Canada. METHODS: We used the Aggregate Analysis of ClinicalTrials.gov (AACT) database, and included all industry-sponsored drug CTs that were conducted in Canada and completed in 2016. We estimated the costs of the study drugs using the market price. Estimates of the costs of management and patient services were based on industry contracts. RESULTS: The sample included 394 CTs that were conducted in 2039 facilities in Canada and provided services for 20,126 Canadian enrollees. Two-thirds of the CTs (277 of 394) were in the non-cancer category. On average, the drug costs per patient were 89,680 Canadian dollars ($Can) during the lifespan of the CTs, and were higher in cancer CTs than in non-cancer CTs ($Can216,876 vs. $Can65,274). The total costs of industry-sponsored drug CTs completed in 2016 was $Can2093.7 million. Drug costs accounted for the majority of this total ($Can1804.9 million). Ontario ($Can781.2 million) and Quebec ($Can757.5 million) had the highest costs. CONCLUSION: The costs of industry-sponsored drug CTs completed in 2016 when measured in terms of market prices in Canada were valued at $Can2.1 billion.

Publicly funded clinical research in Canada.

Clinical research is funded by industry, governments, charities, and hospitals. It is important to know the economic commitment of the various funding bodies, but until now there has been no national source available which provides these data. We surveyed the major funders to provide such a measure. There is evidence that government and charity funding of medical research is a trigger for private sector research investment; therefore, tracking all sources of funding for clinical research will provide policy-makers with an overall picture of health research funding. These data support policy decision-making related to clinical research in Canada.

The Costs of Industry-Sponsored Medical Device Clinical Trials in Alberta.

OBJECTIVE: Our objective was to describe the costs of industry-sponsored clinical trials for medical devices in Northern Alberta, Canada. METHODS: We used centralized data to identify all industry-sponsored medical device clinical trials initiated in Northern Alberta from 2012 to 2016. For each arm of each trial, we calculated the price of devices provided by the sponsor and the cost of clinical and administrative services that were incurred to clinically operationalize the treatment. RESULTS: Our sample consisted of 18 device trials initiated between January 2012 and January 2016. The overall cost (Canadian dollars [$Can], year 2018 values) per enrolee was $Can18,243 for the experimental arm and $Can13,827 for the control arm. Devices were the highest cost component, at $Can13,446 per enrollee in the experimental arm. Clinical costs in the control arms were higher on average ($Can7202 vs. 2504) than those in the experimental arms. CONCLUSION: Data from industry-sponsored clinical trials can provide important information on the full costs of device-related interventions. As device costs rise, and as policy makers require more evidence on device-related treatments, the cost of medical device-driven interventions should be documented along with their effectiveness.

Incremental costs of high intensive care utilisation in patients hospitalised with heart failure.

AIMS: Registries have reported large inter-hospital differences in intensive care unit admission rates for patients with acute heart failure, but little is known about the potential economic impact of over-admission of low-risk patients with heart failure to higher cost intensive care units. We described the variability in intensive care unit admission practices, the provision of critical care therapies, and estimated the potential national cost savings if all hospitals adopted low intensive care unit admission practices for patients admitted with heart failure. METHODS: Using a national population health dataset, we identified 349,693 heart failure admission hospitalisations with a primary diagnosis of heart failure between 2007 and 2016. Hospitals were categorised as low (first quartile), medium (second and third quartile) and high (fourth quartiles) intensive care unit utilisation. RESULTS: The mean intensive care unit admission rate was 16.4% (inter-hospital range 0.3-51%) including 5.4% in low, 14.5% in medium and 30% in high utilisation hospitals. Intensive care unit therapies in low, medium and high intensive care unit utilisation hospitals were 54.5%, 45.1% and 24.1% (P<0.001), respectively and the inhospital mortality rate was not significantly different. The proportion of hospital costs incurred by intensive care unit care was 7.8% in low, 19.8% in medium and 28.2% in high (P<0.001) admission hospitals. The potential cost savings of altering intensive care unit utilisation practices for patients with heart failure was CAN$234.8m over the study period. CONCLUSIONS: In a national cohort of patients hospitalised with heart failure, we observed that low intensive care unit utilisation centres had lower hospital costs with no differences in mortality rates. The development of standardised admission criteria for high-cost and high acuity intensive care unit beds could reduce costs to the healthcare system.

Association between strained ICU capacity and healthcare costs in Canada: A population-based cohort study.

BACKGROUND: Intensive care is resource intensive, with costs representing a substantial quantity of total hospitalization costs. Strained ICU capacity compromises care quality and adversely impacts outcomes; however, the association between strain and healthcare costs has not been explored. MATERIALS AND METHODS: Population-based cohort study performed in 17 adult ICUs in Alberta, Canada. Data were captured on hospitalizations, ambulatory care, physician services and drug dispenses occurring 1-year before and 1-year after index ICU admission. Strain was defined as occupancy ≥90%; with 21 additional definitions evaluated. Patients were categorized as strain and non-strain admissions. Costs attributable to strain, were calculated as difference-in-difference costs using propensity-score matching. RESULTS: 30,557 patients were included (strain: 11,830 [38.7%]; non-strain: 18,727 [61.3%]). At 1-year, strain admissions had adjusted-incremental per-patient cost of CA$9406 (95%CI, $5654-13,157) compared to non-strain admissions, due to hospitalization costs (CA$7930; 95%CI, $4553-11,307) and physician claims (CA$844; 95%CI, $430-1259). This equated to CA$111.3 million (95%CI, $66.9-155.6 million) in excess attributable costs. Strain portended longer hospitalization (3.3 days; 95%CI, 1.1-5.5); and more ambulatory visits (1.0; 95%CI, 0.1-2.0) and physician claims (9.5; 95%CI, 6.2-12.7). Incremental costs were robust across strain definitions. CONCLUSIONS: Admissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.

Total and Cause-Specific Mortality After Percutaneous Coronary Intervention: Observations From the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Registry.

BACKGROUND: Patients undergoing percutaneous coronary intervention (PCI) are increasingly older and have a higher comorbidity burden. This study evaluated trends in 30-day, 1-year, and 2-year total and cause-specific mortality using a large, contemporary cohort of patients who underwent PCI in Alberta, Canada. METHODS: We used the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry to identify patients aged ≥ 20 years who underwent PCI between 2005 and 2013. All patients were followed until death or being censored by August 2016. Cause of death was from the Vital Statistics database and classified as cardiac or noncardiac. Multivariable logistic regression was used to calculate predicted mortality at 30 days, 1 year, and 2 years post-PCI. RESULTS: Of the 35,602 patients who underwent PCI, 5284 (14.8%) had died. Mean (standard deviation) follow-up was 74.9 (35.1) months. Over the study period, patients were older and more likely to undergo PCI for an acute coronary syndrome indication. Thirty-day (2005: 1.3%; 2013: 3.2%; P < 0.001), 1-year (2005: 2.7%; 2013: 5.7%; P < 0.001), and 2-year (2005: 4.5%; 2013: 7.5%; P < 0.001) predicted mortality after PCI increased over the study period. Cardiac cause of death dominated in the short-term, but the proportion of noncardiac deaths increased as time from PCI to death increased (30 days = 11.5%, 1 year = 31.5%, 2 years = 39.6%; P < 0.001). CONCLUSIONS: In this population-based study, we found all-cause mortality at 30 days, 1 year, and 2 years after PCI increased over time. Cardiac causes of death dominate in the short-term after PCI; however, noncardiac cause becomes a major driver of mortality in the long-term.

CONTEXTE: Les patients devant subir une intervention coronarienne percutanée (ICP) sont de plus en plus âgés et subissent un fardeau accru de comorbidités. La présente étude a évalué les tendances de la mortalité totale et due à une cause particulière à 30 jours, 1 an et 2 ans, au sein d'une vaste cohorte contemporaine de patients ayant subi une ICP en Alberta, au Canada. MÉTHODOLOGIE: Nous avons utilisé le registre APPROACH (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) pour recenser les patients âgés de 20 ans ou plus qui avaient subi une ICP entre 2005 et 2013. Tous les patients ont fait l'objet d'un suivi jusqu'au décès ou à la censure des données en août 2016. La cause du décès était issue de la Base de données sur l'état civil et classée comme étant d'origine cardiaque ou non cardiaque. On a eu recours à un modèle de régression logistique multivarié pour calculer la mortalité prédite 30 jours, 1 an et 2 ans après l'ICP. RÉSULTATS: Sur les 35 602 patients ayant subi une ICP, 5 284 (14,8 %) étaient décédés. La durée moyenne de suivi (écart type) était de 74,9 (35,1) mois. Au cours de la période de l'étude, les patients étaient plus âgés et plus susceptibles de subir une ICP pour une indication de syndrome coronarien aigu. On observe une augmentation de la mortalité prédite après l'ICP au cours de la période de l'étude selon les taux suivants : à trente jours (2005 : 1,3 %; 2013 : 3,2 %; p < 0,001), à 1 an (2005 : 2,7 %; 2013 : 5,7 %; p < 0,001) et à 2 ans (2005 : 4,5 %; 2013 : 7,5 %; p < 0,001). Les causes cardiaques de décès dominaient à court terme, mais la proportion de décès d'origine non cardiaque augmentait avec le temps au fur et à mesure de l'allongement de l'intervalle entre la date de l'ICP et le décès (30 jours = 11,5 %, 1 an = 31,5 %, 2 ans = 39,6 %; p < 0,001). CONCLUSIONS: Dans cette étude de population, nous avons trouvé que la mortalité toutes causes confondues à 30 jours, 1 an et 2 ans après une ICP augmente au fil du temps. Les causes cardiaques de décès dominent peu de temps après l'ICP, tandis que les causes non cardiaques jouent un rôle déterminant dans la mortalité à long terme.

Resource Use and Burden of Hospitalization, Outpatient, Physician, and Drug Costs in Short- and Long-term Care After Acute Myocardial Infarction.

BACKGROUND: Little is known about the resource use and cost burden of acute myocardial infarction (AMI) beyond the index event. We examined resource use and care costs during the first and each subsequent year, among patients with incident AMI. METHODS: Patients aged ≥18 years who were admitted with incident AMI at emergency departments or hospitals in Alberta, Canada, between April 2004 and March 2014 were included. Incident cases were defined as those without an AMI hospitalization in the previous 10 years. Inpatient, outpatient, practitioner claims, drug claims, and vital statistics were linked and follow-up data were available until March 2016. Resource use and care costs per patient for each year after the AMI were calculated. RESULTS: The analysis included 41,210 patients with incident AMI (non-ST-segment elevation myocardial infarction [NSTEMI] = 50.8%, ST-segment elevation myocardial infarction = 36.8%, and undefined myocardial infarction [MI] = 12.5%). Resource use and care costs were highest during the first year. Compared with other MI groups, patients with ST-segment elevation myocardial infarction had more frequent outpatient visits (mean 1.64 vs 0.99 [NSTEMI] and 0.87 [undefined MI] visits) but spent fewer days in hospital (mean 7.72 vs 9.23 [NSTEMI] and 8.5 [undefined MI] days) during the first year. AMI costs were $19,842 during the first year and $845 per year for the next 5 years. Hospitalization costs accounted for the majority of costs during the first year (81.1%), whereas drug costs did for the next 5 years (62.1%). CONCLUSIONS: The long-term annual cost burden of AMI is modest compared with care costs during the first year. Although hospitalization dominates first year costs, pharmaceuticals do so in the long term.

The high cost of critical care unit over-utilization for patients with NSTE ACS.

BACKGROUND: There is substantial variability among hospitals in critical care unit (CCU) utilization for patients admitted with non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS). We estimated the potential cost saving if all hospitals adopted low CCU utilization practices for patients with NSTE ACS. METHODS: National hospital claims data were used to identify all patients with a primary diagnosis of NSTE ACS initially admitted to an acute care hospital between 2007 and 2013. Hospital CCU utilization was classified as low (<30%), medium (30-70%), or high (>70%). RESULTS: Among the 270,564 NSTE ACS hospitalizations (71.6% non-ST-segment elevation myocardial infarction; 28.4% unstable angina) admitted to 261 hospitals, 41.9% (inter-hospital range 0.3%-95.1%) were admitted to a CCU. The proportion of patients admitted to a CCU in low, medium and high utilization hospitals was 16.3%, 49.5%, and high 81.1%, respectively. No differences in adjusted inpatient mortality were observed by hospital CCU utilization. The overall inpatient costs of caring for NSTE ACS were $1.1 billion. CCU care accounted for 45.2% of all hospitalization costs including 22.6%, 49.9%, and 69.0% (P < .001) of costs in low, medium and high utilization centers. The national potential direct cost savings of medium and high CCU utilization centers adopting low NSTE ACS CCU utilization practices was $113.4 million over the study period. CONCLUSIONS: In a population-based contemporary cohort, CCU utilization for patients with NSTE ACS varied widely and in-hospital mortality was similar between low, medium and high utilization centers. CCU care accounted for 45% of hospitalization costs; thus, implementing policies and admission practices to align hospital resources with patient care needs have the potential to reduce overall health care costs.

A Population-Based Cohort Study Evaluating Outcomes and Costs for Syncope Presentations to the Emergency Department.

OBJECTIVES: This study sought to examine outcomes and costs of patients with syncope admitted and discharged from the emergency department (ED). BACKGROUND: ED visits for syncope are common, yet the impact on health care utilization is relatively unknown. METHODS: A total of 51,831 consecutive patients presented to the ED with a primary diagnosis of syncope (International Classification of Diseases-9 code 780.2 and International Classification of Diseases-10 code R55) in Alberta, Canada from 2006 to 2014. Outcomes included 30-day syncope ED and hospital readmissions; 30-day and 1-year mortality; and annual inpatient, outpatient, physician, and drug costs, cumulative. RESULTS: Of adults presenting to the ED, 6.6% were hospitalized and discharged with a primary diagnosis of syncope (Cohort 1), 8.7% were hospitalized and discharged with a primary diagnosis other than syncope (Cohort 2), and 84.7% were discharged home with a syncope diagnosis (Cohort 3). The 30-day ED revisits for syncope varied from 1.2% (Cohort 2) to 2.4% (Cohort 1) (p < 0.001), and readmission rates were <1% among cohorts. Short- and long-term mortality rates were highest for Cohort 2 and lowest for Cohort 3 (30-day mortality: Cohort 1 of 1.2%, Cohort 2 of 5.2%, Cohort 3 of 0.4%; p < 0.001) (1-year mortality: Cohort 1 of 9.2%, Cohort 2 of 17.7%, Cohort 3 of 3.0%; p < 0.001). Total cost of syncope presentations was $530.6 million (Cohort 1: $75.3 million; $29,519/patient, Cohort 2: $138.1 million; $42,042/patient, Cohort 3: $317.3 million; $9,963/patient; p<0.001). CONCLUSIONS: Most patients with syncope presenting to the ED were discharged and had a favorable prognosis but overall costs were high compared with patients hospitalized. Further research is needed for cost-saving strategies across all cohorts.

The Healthcare Cost Burden of Acute Myocardial Infarction in Alberta, Canada.

OBJECTIVES: Little is known about the cost burden of acute myocardial infarction (AMI) on healthcare systems. Accordingly, we examined the long-term trends of healthcare costs for AMI in the province of Alberta, Canada. METHODS: We linked five Albertan health databases, including ambulatory care, hospitalization, practitioner claims, pharmaceutical information network, and population registry to identify patients with a primary diagnosis of AMI between 2004 and 2013. We used the Alberta Interactive Health Data Application to provide unit costs for ambulatory care and inpatient services, claim paid amounts for physician services, and the Alberta Drug Benefit List for drug prices. Healthcare costs for AMI were grouped into ambulatory care, hospitalization, physician costs, and drug costs. All costs were converted to 2016 Canadian dollar values ($Can). RESULTS: A total of 52,912 patients with AMI were included in the analysis. Patient age decreased over time, as did the proportion of females. AMI cost the Alberta healthcare system Can$1033 million during the study period; of which the largest proportion was hospitalization costs (Can$716.4 million, 63.1%), followed by drug costs (Can$147.2 million, 21.1%), ambulatory care costs (Can$94.5 million, 8.8%) and physician costs (Can$74.9 million, 7.0%). The cost per AMI hospitalization decreased from Can$14,116 in 2004 to Can$11,792 in 2013 (p < 0.001). CONCLUSIONS: Healthcare costs for AMI are significant; however, they decreased slightly during the study period. Hospital services accounted for the largest share of the costs. There are opportunities for further savings in AMI care.

The Economic Contribution of Industry-Sponsored Pharmaceutical Clinical Trials.

PURPOSE: In pharmaceutical clinical trials, industrial sponsors pay for study drugs and related healthcare services. We conducted a study to determine industry's economic contribution of these trials to the Alberta healthcare system.  Methods: We used data from two trial centers for cancer and non-cancer trials at the University of Alberta. For each trial (cancer, non-cancer), we calculated the cost of drugs provided by the sponsors using the market price, the cost of clinical services, and the cost of administrative services that they paid. We extrapolated these results to all trials in Alberta based on information obtained from the registration website ClinicalTrials.gov.  Results: Our sample consisted of 40 non-cancer and 39 cancer drug trials which were initiated in 2012. The monetary value of the industry sponsors' contribution was $799,055 per non-cancer and $630,243 per cancer drug trial. Drugs (in-trial and post-trial) accounted for 84% of the total contribution of the non-cancer drug trials whereas it represented 93% of all trial-related contributions in the cancer category. The total province-wide contribution of industry-sponsored drug trials which were initiated in 2012 was estimated to be $101 million, including open-label drugs in the non-cancer category.  Conclusions: Industry-sponsored pharmaceutical trials represent a major economic contributor to clinical research within the province.

Cost of Congenital Heart Disease Hospitalizations in Canada: A Population-Based Study.

BACKGROUND: The prevalence of congenital heart disease (CHD) is rising, and late complications are common. The impact of these factors on health-care costs is not well understood. We sought to describe inpatient CHD costs in Canada. METHODS: We conducted an observational retrospective cohort study. The Canadian Institute for Health Information (CIHI) Discharge Abstract Database was used for all Canadian provinces, except Quebec, between April 2004 and March 2014. We included hospitalizations with a main diagnosis of CHD (International Classification of Diseases, 10th revision, codes Q20.0-26.9) and hospitalizations having CHD as a secondary diagnosis if the main diagnosis was a comorbid condition related to CHD. CIHI patient cost estimates were used to provide dollar values. Costs were inflated to 2016 Canadian dollars. RESULTS: Among 59,917 hospitalizations, annual CHD costs increased by 21.6% from CAD$99.7 million (95% confidence interval [CI], $89.4-$110.1 million) in 2004 to $121.2 million (95% CI, $112.8-$129.6 million) in 2013 (P < 0.001). Costs were higher for children compared with adults. However, the cost increase was greater in adults (4.5%/y; P < 0.001) than in children (0.7%/y; P = 0.006). Adults accounted for 38.2% of costs in 2004 vs 45.8% in 2013 (P = 0.002). Costs increased most among adults with complex CHD (7.2%/y; P = 0.001). Adult men accounted for greater increases in costs relative to women (P < 0.001). Length of stay was unchanged over time. CONCLUSIONS: Inpatient CHD costs are increasing independent of inflation, particularly among adults with complex lesions. Although children still account for greater inpatient CHD costs, a larger increase was observed among adults. These data are important in allocating inpatient resources for adults with CHD.

The current and future financial burden of hospital admissions for heart failure in Canada: a cost analysis.

BACKGROUND: Heart failure is a costly health condition and a major public health concern. We sought to examine the costs of hospital admissions for heart failure between fiscal years 2004 and 2013 in Canada and to model the future costs to 2030. METHODS: Canadian Institutes for Health Information Discharge Abstract Database was used to identify admissions to hospital with heart failure as the primary diagnosis between fiscal years 2004 and 2013. Multiple linear regression models were used to calculate the trend in prevalence and extrapolate these to 2030. Canadian Institutes for Health Information patient cost estimates were used to identify costs of hospital admissions for heart failure. Generalized linear models were used to estimate average annual costs per heart failure patient. We conducted a sensitivity analysis including all admissions for heart failure in any diagnostic field. RESULTS: In 2013, 45 600 (95% confidence interval [CI]: 43 800-47 200) patients were admitted with heart failure as the primary diagnosis, accounting for $482 (95% CI $464-$500) million. By 2030, we estimate 54 000 (95% CI 49 000-60 000) patients and costs of $722 (95% CI $650-$801) million, with older adults (age ≥ 80 yr) accounting for 52% of costs. Including admissions for which heart failure was a secondary diagnosis increases the total cost to $2.8 (95% CI $2.6-$3.0) billion in 2030. INTERPRETATION: As in other developed countries, hospital costs related to heart failure in Canada are on the rise. Older adults are the main consumers of such hospital services. Strategies to improve outpatient care to reduce rates of admission for heart failure are needed.

Cost Effectiveness of Eplerenone for the Treatment of Systolic Heart Failure with Mild Symptoms in Alberta, Canada.

BACKGROUND: Eplerenone has been demonstrated as being cost effective for the treatment of patients with systolic heart failure (HF) and mild symptoms in several jurisdictions; however, its cost effectiveness is unknown in the context of Alberta, Canada. METHODS: We used a discrete-event simulation model to compare costs and outcomes between standard care and standard care plus eplerenone for the treatment of HF with mild symptoms. We used Alberta data (whenever possible) together with a healthcare perspective, a lifetime horizon, and 3 % annual discount rate for analyses. RESULTS: Clinically, eplerenone prevented HF hospitalizations, atrial fibrillations, and cardiovascular (CV) deaths, but incurred more adverse events and device implantations than standard care. The remaining life of patients receiving eplerenone was 7.08 versus 5.83 years for those receiving standard care. Eplerenone gained 1.25 life-years and 1.18 quality-adjusted life-years (QALYs), with an incremental cost of $Can7200. Therefore, the incremental cost-effectiveness ratio (ICER) was $Can5700 per life-year gained and $Can6100 per QALY gained. CONCLUSIONS: Given the most cited ICER threshold is $Can50,000, the use of eplerenone as an adjunct to standard care for treating patients with systolic HF and mild symptoms is cost effective in the context of Alberta. Eplerenone would cost the Alberta health system about $Can4.6 million a year in drug costs. Incorporating reductions in health services utilization associated with eplerenone, the budget impact is smaller. For the first year, the use of eplerenone is cost saving and for 5 years the cost is approximately $Can6 million.