Understanding Real-World Trends in High Costs, Comorbidities, and Mortality: A Percentile-Based Cohort Comparison in Severe Obesity

Speaker(s)

Aggarwal S1, Kumar S2, Topaloglu O3
1NOVEL Health Strategies, Chevy Chase, MD, USA, 2NOVEL HEALTH STRATEGIES, COLUMBIA, MD, USA, 3NOVEL Health Strategies, Bethesda, MD, USA

OBJECTIVES: To assess real-world trends and drivers of costs and comorbidities using a multiple cohort design in a case study of severe obesity.

METHODS: National Inpatient Sample (NIS) records for 2016 were searched for cases of severe obesity due to excess calories. Five cohorts were created: (1) all hospitalizations, (2) hospitalizations above the 90th percentile by charges, (3) hospitalizations below the 90th percentile by charges, (4) hospitalizations above the 90th percentile by comorbidity score, and (5) hospitalizations below the 90th percentile by comorbidity score. Comorbidity rates were assessed using three methods: the Charlson Index, the Elixhauser method, and broad ICD-10 categories.

RESULTS: In 2016, there were an estimated 1,884,275 hospitalizations in the United States with a diagnosis of severe obesity due to excess calories. The mean hospital length of stay (LOS) in the five cohorts was as follows: all hospitalizations - 4.97 days (SD 6.18), above the 90th percentile by charges - 11.42 days (SD 13.25), below the 90th percentile by charges - 4.06 days (SD 3.48), above the 90th percentile by comorbidity score - 8.59 days (SD 9.19), and below the 90th percentile by comorbidity score - 4.77 days (SD 5.9). The total charges were $56,643 (SD 83,559), $220,997 (SD 184,653), $38,382 (SD 25,195.94), $90,944 (SD 128,081.81), and $54,748 (SD 79,955), respectively. The mortality rates in the five cohorts were 1.53%, 4.92%, 1.05%, 6.34%, and 1.26%, respectively. The highest LOS, charges, and mortality were observed in the 90th percentile cohorts by charges and comorbidity score. The comorbidity rates showed similar trends. For example, for congestive heart failure, the rates in the five cohorts were 26%, 33%, 25%, 83%, and 23%.

CONCLUSIONS: Analyses of real-world evidence by top percentiles in terms of charges and comorbidity scores may help providers and payers develop more efficient patient management systems.

Code

EE322

Topic

Economic Evaluation

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity)