Deborah Hwang1, Joan M Teno2, Pedro Gozalo1, Susan Mitchell3. 1. The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. 2. The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Electronic address: jmteno76@mac.com. 3. Harvard Medical School, Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts, USA.
Abstract
CONTEXT: The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs. OBJECTIVES: To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization. METHODS: Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design. RESULTS: Matched residents with (n=1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n=1924, unique n=4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P=0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference=$1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference=0.34, 0.92 days). CONCLUSION: In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.
CONTEXT: The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs. OBJECTIVES: To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization. METHODS: Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design. RESULTS: Matched residents with (n=1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n=1924, unique n=4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P=0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference=$1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference=0.34, 0.92 days). CONCLUSION: In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.
Authors: Joan M Teno; Susan L Mitchell; Pedro L Gozalo; David Dosa; Amy Hsu; Orna Intrator; Vincent Mor Journal: JAMA Date: 2010-02-10 Impact factor: 56.272
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Ata A Rahnemai-Azar; Amir A Rahnemaiazar; Rozhin Naghshizadian; Amparo Kurtz; Daniel T Farkas Journal: World J Gastroenterol Date: 2014-06-28 Impact factor: 5.742
Authors: C Tudor; C Branescu; C Savlovschi; A El-Khatib; H Pantu; A Nica; A M Dascalu; B Masoumeh; A S Tudor; S M Oprescu; D Serban Journal: J Med Life Date: 2016 Oct-Dec