The financial impact of heparin-induced thrombocytopenia.
BACKGROUND
Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT.


METHODS
A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared.


RESULTS
Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected.


CONCLUSIONS
For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.
Smythe
Maureen A
MA
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI. Electronic address: msmythe@beaumont.edu.
Koerber
John M
JM
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI.
Fitzgerald
Maureen
M
Department of Financial Services, William Beaumont Hospital, Royal Oak, MI.
Mattson
Joan C
JC
Clinical Pathology, William Beaumont Hospital, Royal Oak, MI.
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006493:Heparin / Q000009:adverse effects*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000191:economics* / Q000628:therapy; D014481:United States
D000925:Anticoagulants; D006493:Heparin