Burden of Hospitalizations in Amyotrophic Lateral Sclerosis (ALS): Comparison of Medicare and Private Payer Populations

OBJECTIVES:

To assess the burden of hospitalizations due to ALS and compare the trends in Medicare and private payer populations .

METHODS: The 2016 National Inpatient Sample (NIS) data set from the Healthcare Cost and Utilization Project was utilized in order to analyze hospital admission records for patients with ALS. Two cohorts of patients were designed: ALS under Medicare and ALS under private payers. Thirty comorbidities were assessed using Elixhauser scoring. Multivariate logistic regression was conducted to assess predictor variables for LOS and costs.

RESULTS:

In 2016, there were an estimated 1465 and 400 ALS related hospitalizations under Medicare and private insurance. The ALS patient age, gender and age differed in the two cohorts: Age 69.85 (SD 10.49) vs 58.96 (SD 9.1) years, Male 47% vs 58% and White 74% vs 80%, in Medicare and private insurance, respectively. Median comorbidity score in Medicare was 4 and 3 in private insured patients. Interestingly, despite relatively lower comorbidity score, the hospital LOS and charges were higher in private insurance: LOS 6.60 vs 10.71 days, and charges $52,889 vs $85,316 (both p<0.05), suggesting potential under treatment under Medicare. The in-patient mortality rate was relatively high and similar in two cohorts 13.65% vs12.50% (p>0.05). Top comorbidities were weight loss, hypertension and Chronic Pulmonary Disease.

CONCLUSIONS: ALS patients have a relatively high rate of mortality and pose a high burden on the healthcare system. There is a need for new treatments to improve outcomes in these patients.