OBJECTIVES: Health care spending in the US is expected to grow from $4.1 trillion in 2020 to $6.8 trillion by 2030, according to the Centers for Medicare & Medicaid Services. Emergency room (ER) visits are one of the driving factors behind high health care costs in the US. This study analyzed the cost of an ER visit in adults & pediatrics in the US and the disease conditions associated with the ER visit.

METHODS: In this retrospective study, the cost for ER visits was estimated based on age cohorts (adults - 18 years and above and pediatrics - below 18 years) for 3 different time-period from 2018-2021 (1st July to 30th June was selected for year-on-year comparison), using the Optum’s de-identified Clinformatics Data Mart database. The data was analyzed for diseases based on ICD-10-CM codes and services used based on the CPT codes.

RESULTS: For 1^st July 2020 to 30^th June 2021, the top three procedures based on the per-patient cost in adults were surgical procedures on the spine (vertebral column, $182,013), on the humerus (upper arm) and elbow ($79,082), and on the forearm and wrist ($53,231). Whereas in pediatrics the top three procedures were cardiovascular procedures ($18,147), chiropractic manipulative treatment procedures ($12,599), and diagnostic imaging ($10,152). The top three diseases in adults were hypertensive disorders ($60,733), abnormalities of breathing ($39,865), and heartbeat ($34,446). Whereas in pediatrics the top three diseases were hazards related to communicable diseases ($13,341), inflammatory polyarthritis ($5,595), and cognition/perception/emotional state disorders ($5,523). Further trend analysis over the study period of three years and statistical tests will be performed.

CONCLUSIONS: This research can help to identify the cost burden of disease in ER and can support other research, policies, and health programs. Cost of disease data will help policymakers find ways to lower the economic burden of the top diseases.