The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia. Goldfeld, K., S., Hamel, M., B., & Mitchell, S., L. Journal of pain and symptom management, U.S. Cancer Pain Relief Committee. Published by Elsevier Inc, 4, 2013.
abstract   bibtex   
CONTEXT: Nursing home (NH) residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve quality of life. Cost-effectiveness analyses of decisions to hospitalize these residents have not been reported. OBJECTIVES: To estimate the cost-effectiveness of 1) not having a do-not-hospitalize (DNH) order and 2) hospitalization for suspected pneumonia in NH residents with advanced dementia. METHODS: NH residents from 22 NHs in the Boston area were followed in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study conducted between February 2003 and February 2009. We conducted cost-effectiveness analyses of aggressive treatment strategies for advanced dementia residents living in NHs when they suffer from acute illness. Primary outcome measures included quality-adjusted life days (QALDs) and quality-adjusted life years, Medicare expenditures, and incremental net benefits (INBs) over 15 months. RESULTS: Compared with a less aggressive strategy of avoiding hospital transfer (i.e., having DNH orders), the strategy of hospitalization was associated with an incremental increase in Medicare expenditures of $5972 and an incremental gain in quality-adjusted survival of 3.7 QALDs. Hospitalization for pneumonia was associated with an incremental increase in Medicare expenditures of $3697 and an incremental reduction in quality-adjusted survival of 9.7 QALDs. At a willingness-to-pay level of $100,000/quality-adjusted life years, the INBs of the more aggressive treatment strategies were negative and, therefore, not cost effective (INB for not having a DNH order, -$4958 and INB for hospital transfer for pneumonia, -$6355). CONCLUSION: Treatment strategies favoring hospitalization for NH residents with advanced dementia are not cost effective.
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 title = {The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia},
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 year = {2013},
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 publisher = {U.S. Cancer Pain Relief Committee. Published by Elsevier Inc},
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 city = {Department of Population Health, New York University School of Medicine, New York, New York, USA. Electronic address: Keith.Goldfeld@nyumc.org.},
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 notes = {ID: 65499; CI: Copyright (c) 2013; JID: 8605836; 2012/08/27 [received]; 2012/11/14 [revised]; 2012/12/07 [accepted]; aheadofprint},
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 abstract = {CONTEXT: Nursing home (NH) residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve quality of life. Cost-effectiveness analyses of decisions to hospitalize these residents have not been reported. OBJECTIVES: To estimate the cost-effectiveness of 1) not having a do-not-hospitalize (DNH) order and 2) hospitalization for suspected pneumonia in NH residents with advanced dementia. METHODS: NH residents from 22 NHs in the Boston area were followed in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study conducted between February 2003 and February 2009. We conducted cost-effectiveness analyses of aggressive treatment strategies for advanced dementia residents living in NHs when they suffer from acute illness. Primary outcome measures included quality-adjusted life days (QALDs) and quality-adjusted life years, Medicare expenditures, and incremental net benefits (INBs) over 15 months. RESULTS: Compared with a less aggressive strategy of avoiding hospital transfer (i.e., having DNH orders), the strategy of hospitalization was associated with an incremental increase in Medicare expenditures of $5972 and an incremental gain in quality-adjusted survival of 3.7 QALDs. Hospitalization for pneumonia was associated with an incremental increase in Medicare expenditures of $3697 and an incremental reduction in quality-adjusted survival of 9.7 QALDs. At a willingness-to-pay level of $100,000/quality-adjusted life years, the INBs of the more aggressive treatment strategies were negative and, therefore, not cost effective (INB for not having a DNH order, -$4958 and INB for hospital transfer for pneumonia, -$6355). CONCLUSION: Treatment strategies favoring hospitalization for NH residents with advanced dementia are not cost effective.},
 bibtype = {article},
 author = {Goldfeld, K S and Hamel, M B and Mitchell, S L},
 journal = {Journal of pain and symptom management}
}

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