Sikachi Rutuja R, Sahni Sonu, Mehta Dhruv, Agarwal Abhishek, Agrawal Abhinav
Department of Pulmonary, Critical Care and Sleep Medicine Northwell Health New Hyde Park, USA.
Adv Respir Med. 2017;85(2):77-86. doi: 10.5603/ARM.2017.0014.
Pulmonary hypertension (PH) is a disorder of the pulmonary vasculature with high mortality and bears a large economic burden on the healthcare system. We conducted a review of the largest inpatient database in the United States and analyzed the trends in hospitalizations due to PH from the turn of the century (2000) to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with PH.
We analyzed the National Inpatient Sample Database (NIS) for all patients in which PH (Primary or Secondary) or cor pulmonale was the primary discharge diagnosis (ICD-9: 416.0, 416.8 and 416.9) from 2000 to 2013. The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, lengths of stays and associated hospital costs over the study period was calculated.
In 2000, there were 12,066 hospital admissions with the principal discharge diagnosis of pulmonary hypertension, which increased to 13,605 admissions in 2013 (p < 0.001). The mean length of stay for PH increased from 5.89 days to 6.67 days during this period (p = 0.04). During the same period, the hospital charges increase by 174.5% from US$ 24,973 in 2000 to US$ 68,545 in 2013 (Adjusted for inflation). The aggregate cost of hospital visits of a patient increased by 209.5% from US$ 301,324,218 in 2000 to US$ 932,554,725 in 2013.
The number of inpatient discharges related to PH has increased even though the number of inpatient discharges with PAH has been reported to be lower in literature. The mean length of stay has also shown a mild increase. This increase is associated with a significant increase in the mean and aggregate cost. These inpatient costs associated with PH contribute significantly to the total healthcare burden. Further research on cost-effective evaluation and management of PH is required.
肺动脉高压（PH）是一种肺部血管疾病，死亡率高，给医疗系统带来巨大经济负担。我们对美国最大的住院患者数据库进行了回顾，并分析了从世纪之交（2000年）到2013年因PH导致的住院趋势，以评估住院率，并确定与PH相关的成本和死亡率。
我们分析了国家住院患者样本数据库（NIS）中2000年至2013年所有以PH（原发性或继发性）或肺心病作为主要出院诊断（国际疾病分类第九版：416.0、416.8和416.9）的患者数据。NIS是美国最大的全付费者住院患者数据库，每年包含约800万次住院的数据。计算了研究期间医院出院人数、住院时间和相关医院成本差异的统计学显著性。
2000年，有12066例以肺动脉高压为主要出院诊断的住院病例，到2013年增加到13605例（p<0.001）。在此期间，PH患者的平均住院时间从5.89天增加到6.67天（p=0.04）。同期，医院收费从2000年的24973美元增加了174.5%，到2013年达到68545美元（经通货膨胀调整）。一名患者的住院总费用从2000年的301324218美元增加了209.5%，到2013年达到932554725美元。
尽管文献报道肺动脉高压（PAH）的住院出院人数较低，但与PH相关的住院出院人数仍有所增加。平均住院时间也略有增加。这种增加与平均成本和总成本的显著增加相关。这些与PH相关的住院成本对医疗总负担有重大贡献。需要对PH的成本效益评估和管理进行进一步研究。
