@article{
 title = {The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia},
 type = {article},
 year = {2013},
 identifiers = {[object Object]},
 month = {4},
 publisher = {U.S. Cancer Pain Relief Committee. Published by Elsevier Inc},
 day = {6},
 city = {Department of Population Health, New York University School of Medicine, New York, New York, USA. Electronic address: Keith.Goldfeld@nyumc.org.},
 id = {4affe2bf-9078-3a85-af6f-fd1f6882b155},
 created = {2016-08-21T22:17:15.000Z},
 file_attached = {false},
 profile_id = {217ced55-4c79-38dc-838b-4b5ea8df5597},
 group_id = {408d37d9-5f1b-3398-a9f5-5c1a487116d4},
 last_modified = {2017-03-14T09:54:45.334Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 notes = {ID: 65499; CI: Copyright (c) 2013; JID: 8605836; 2012/08/27 [received]; 2012/11/14 [revised]; 2012/12/07 [accepted]; aheadofprint},
 folder_uuids = {06be5eb7-ff2d-415d-a16d-66085b37f653},
 private_publication = {false},
 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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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","bibtex":"@article{\n title = {The Cost-Effectiveness of the Decision to Hospitalize Nursing Home Residents With Advanced Dementia},\n type = {article},\n year = {2013},\n identifiers = {[object Object]},\n month = {4},\n publisher = {U.S. Cancer Pain Relief Committee. Published by Elsevier Inc},\n day = {6},\n city = {Department of Population Health, New York University School of Medicine, New York, New York, USA. 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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). 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