Hospital costs for unplanned re‐admissions within 30 days of hospitalisations with heart failure, Australia, 2013–2017: a retrospective cohort study

Abstract

AbstractObjectivesTo assess the direct hospital costs for unplanned re‐admissions within 30 days of hospitalisations with heart failure in Australia; to estimate the proportion of these costs attributable to potentially preventable re‐admissions.Study designRetrospective cohort study; analysis of linked admitted patient data collections data.Setting, participantsPeople admitted to hospital (all public and most private hospitals in Australia) with primary diagnoses of heart failure, 1 January 2013 – 31 December 2017, who were discharged alive and re‐admitted to hospital at least once (any cause) within 30 days of discharge.Main outcome measuresEstimated re‐admission costs based on National Hospital Cost Data Collection, by unplanned re‐admission category based on the primary re‐admission diagnosis: potentially hospital‐acquired condition; recurrence of heart failure; other diagnoses related to heart failure; all other diagnoses. The first two groups were deemed the most preventable.ResultsThe 165 612 eligible hospitalisations of people with heart failure during 2013–2017 (mean age, 79 years [standard deviation, 12 years]; 85 964 men [51.9%]) incurred direct hospital costs of $1881.4 million (95% confidence interval [CI], $1872.5–1890.2 million), or $376.3 million per year (95% CI, $374.5–378.1 million per year) and $11 360 per patient (95% CI, $11 312–11 408 per patient). A total of 41 125 people (24.8%) experienced a total of 58 977 unplanned re‐admissions within 30 days of discharge from index admissions; these re‐admissions incurred direct hospital costs of $604.4 million (95% CI, $598.2–610.5 million), or 32% of total index admission costs; that is, $120.9 million per year (95% CI, $119.6–122.1 million per year), and $14 695 per patient (95% CI, $14 535–14 856 per patient). Re‐admissions with potentially hospital‐acquired conditions (21 641 re‐admissions) accounted for 40.1% of unplanned re‐admission costs, recurrence of heart failure (18 666 re‐admissions) for 35.6% of re‐admission costs.ConclusionUnplanned re‐admissions after hospitalisations with heart failure are expensive, incurring costs equivalent to 32% of those for the initial hospitalisations; a large proportion of these costs are associated with potentially preventable re‐admissions. Reducing the number of unplanned re‐admissions could improve outcomes for people with heart failure and reduce hospital costs.