Health Affairs: Mortality, healthcare spending have minimal correlation

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Little correlation was found between mortality rates and costs for seven of the most common diagnoses, and researchers said that healthcare expenditures may in fact provide inconsistent value, according to the results of a study published in the September issue of Health Affairs.

“As rapid U.S. healthcare spending growth continues, the question of whether additional dollars purchase better health or unnecessary care remains in sharp focus for policy makers, large employers, and other stakeholders,” the authors wrote.

To investigate, Michael B. Rothberg, of Tufts University School of Medicine in Boston, and Baystate Medical Center in Springfield, Mass., and colleagues assessed variations in mortality and cost for seven common diagnoses—acute myocardial infarction, chronic obstructive pulmonary disease, community-acquired pneumonia, congestive heart failure (HF), ischemic stroke, sepsis and urinary tract infection—at 122 U.S. hospital sites between 2000 and 2004.

Researchers used data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), which includes data from an estimated five to eight million hospital stays across 26 states. The researchers used regression models to calculate mortality and cost and adjusted for inflation for each year and diagnoses.

To get results, the researchers calculated the cost per life saved by dividing the absolute change in adjusted cost by the absolute change in adjusted mortality.

Compared to 2000, patients in 2004 were less likely to be white, hold private health insurance and had lower incomes that were listed below $45,000; however, there was a rise in comorbidities and the number of hospital admissions for the seven aforementioned diagnoses increased 6 percent.

The researchers found that admissions for most of the common diagnoses incurred volume changes of less than 10 percent; however, hospital admissions for sepsis increased 42 percent and admissions for urinary tract infections increased by 24 percent.

Additionally, the results showed that relative mortality was 1 percent for sepsis and 21 percent for acute MI. MI, pneumonia and HF exhibited the greatest reductions in mortality, and these are the three diseases that have active public reporting initiatives, the authors noted.

Rothberg and colleagues also found that older patients had larger absolute reductions because they exhibited higher baseline mortality rates. But, for acute MI, the oldest patients had a greater decrease in relative risk and absolute risk.

The researchers also found that costs for all diagnoses increased across the study period and in 2004 costs per case for urinary tract infection and acute MI were $1,251 and $5,047, respectively. Increases in cost were lowest for pneumonia and highest for HF, 26 percent and 60 percent, respectively. And while costs inflated most for those age 55-65, patients 85 and over saw the smallest cost increases.

The researchers found that the additional spending on healthcare that occurred during the time period to be $167,000 for phenomena (per additional life saved) and $834,000 for urinary tract infections and $1.8 million for sepsis.

“As a result, the cost to save one additional life-year as a result of improvements in care varied greatly within and across diagnoses, from as little as $11,900 for an elderly patient with acute MI  to more than $190,000 for a patient of similar age with sepsis,” the authors wrote.

“Over the past thirty years, healthcare spending and spending growth in the U.S. have consistently outpaced those of other developed countries,” the authors wrote. “Unlike some other governments, which have made concerted efforts to assess the cost-effectiveness of the care they provide, the U.S. government has intentionally avoided considerations of cost in care decisions. This decision has contributed to price increases that are not necessarily tied to improvements in quality.

“Current trends in healthcare delivery, such as improved adherence to guidelines and more frequent use of efficacious therapies might be expected to contribute to the decline in mortality from acute MI, pneumonia or congestive HF,” the authors concluded. It is not known, however, what changes in the treatment of stroke, pulmonary disease, or urinary tract infection caused costs to rise by 30 percent and mortality to fall by 14 percent.”

The authors said that future studies are needed to address the correlations between treatments and costs in order