Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism.

BACKGROUND AND AIMS: The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany. METHODS AND RESULTS: We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0 days). CONCLUSIONS: We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.

Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System.

BACKGROUND: Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is entering a growth phase in Europe following a steady increase in the United States (US) in the past decade, but the potential economic impact on European healthcare systems remains unknown. METHODS AND RESULTS: We built two statistical models for the monthly trend of proportion of CDT among patients with severe (intermediate- or high-risk) PE in the US. The conservative model was based on admission data from the National Inpatient Sample (NIS) 2016-2020, and the model reflecting increasing access to advanced treatment from the PERTTM national quality assurance database registry 2018-2021. By applying these models to the forecast of annual PE-related hospitalizations in Germany, we calculated the annual number of severe PE cases and the expected increase in CDT use for the period 2025-2030. The NIS-based model yielded a slow increase, reaching 3.1% (95% CI 3.0-3.2%) among all hospitalizations with PE in 2030; in the PERT-based model, increase would be steeper, reaching 8.7% (8.3-9.2%). Based on current reimbursement rates, we estimated an increase of annual costs for PE-related hospitalizations in Germany ranging from 15.3 to 49.8 million euros by 2030. This calculation does not account for potential cost savings, including those from reduced length of hospital stay. CONCLUSION: Our approach and results, which may be adapted to other European healthcare systems, provide a benchmark for healthcare costs expected to result from CDT. Data from ongoing trials on clinical benefits and cost savings are needed to determine cost-effectiveness and inform reimbursement decisions.

Configurational subdiffusion of peptides: a network study.

Molecular dynamics (MD) simulation of linear peptides reveals configurational subdiffusion at equilibrium extending from 10⁻¹² to 10⁻8 s. Rouse chain and continuous-time random walk models of the subdiffusion are critically discussed. Network approaches to analyzing MD simulations are shown to reproduce the time dependence of the subdiffusive mean squared displacement, which is found to arise from the fractal-like geometry of the accessible volume in the configuration space. Convergence properties of the simulation pertaining to the subdiffusive dynamics are characterized and the effect on the subdiffusive properties of representing the solvent explicitly or implicitly is compared. Non-Markovianity and other factors limiting the range of applicability of the network models are examined.

Subdiffusion in time-averaged, confined random walks.

Certain techniques characterizing diffusive processes, such as single-particle tracking or molecular dynamics simulation, provide time averages rather than ensemble averages. Whereas the ensemble-averaged mean-squared displacement (MSD) of an unbounded continuous time random walk (CTRW) with a broad distribution of waiting times exhibits subdiffusion, the time-averaged MSD, delta2, does not. We demonstrate that, in contrast to the unbounded CTRW, in which delta2 is linear in the lag time Delta, the time-averaged MSD of the CTRW of a walker confined to a finite volume is sublinear in Delta, i.e., for long lag times delta2 approximately Delta1-alpha. The present results permit the application of CTRW to interpret time-averaged experimental quantities.

Subdiffusion in peptides originates from the fractal-like structure of configuration space.

Molecular dynamics simulation of oligopeptide chains reveals configurational subdiffusion at equilibrium extending from 10(-12) to 10(-8) s. Trap models, involving a random walk with a distribution of waiting times, cannot account for the subdiffusion, which is found rather to arise from the fractal-like structure of the accessible configuration space.