title: Endoscopic submucosal dissection for gastric cancer in elderly Japanese patients: an observational study of financial costs of treatment based on a national administrative database.
abstract: OBJECTIVE
  There is currently little information on the medical economic outcomes of endoscopic submucosal dissection (ESD) for gastric cancer (GC) in elderly patients. This study therefore aimed to investigate the medical economic outcomes of ESD in elderly patients with GC using a national administrative database.
  
  
  METHODS
  A total of 27 385 patients treated with ESD for GC were referred to 867 hospitals in Japan from 2009 to 2011. We collected data from the national administrative database and divided them into two groups according to age: elderly patients (≥80 years; n = 5525) and non-elderly patients (<80 years; n = 21 860). We compared ESD-related complications, risk-adjusted length of stay (LOS) and medical costs during hospitalization between elderly and non-elderly patients.
  
  
  RESULTS
  There was no significant difference in ESD-related complications between elderly and non-elderly patients (4.3% vs 3.9%, P = 0.152). However, significant differences were observed in mean LOS and medical costs during hospitalization between the two groups (P < 0.001). Multiple linear regression analysis showed that elderly patients experienced a significantly longer LOS and higher medical costs. The unstandardized coefficient for LOS in elderly patients was 2.71 days (95% confidence interval [CI] 2.59-2.84, P < 0.001), while that for medical costs during hospitalization was USD952.1 (95% CI 847.7-1056.5, P < 0.001).
  
  
  CONCLUSIONS
  LOS and medical costs during hospitalization were significantly higher in elderly patients undergoing ESD for GC than in non-elderly patients, although there was no difference in the incidence of ESD-related complications.
authors.affiliation: Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Murata
authors.forename: Keiji
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Yukako
authors.initials: Y
authors.lastname: Ichimiya
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kubo
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D004210:Dissection / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*
keywords: complication; elderly; endoscopic submucosal dissection; healthcare cost; length of stay; stomach neoplasm