title: The excess cost of interisland transfer of intracerebral hemorrhage patients.
abstract: BACKGROUND
  Currently, intracerebral hemorrhage (ICH) patients from neighbor islands are air transported to a higher-level facility on Oahu with neuroscience expertise. However, the majority of them do not receive subspecialized neurosurgical procedures (SNP) upon transfer. Hence, their transfer may potentially be considered as excess cost.
  
  
  METHODS
  Consecutive ICH patients hospitalized at a tertiary center on Oahu between 2006 and 2013 were studied. Subspecialized neurosurgical procedure was defined as any neurosurgical procedure or conventional cerebral angiogram. Total excess cost was estimated as the cost of interisland transfer multiplied by the number of interisland transfer patients who did not receive any SNP.
  
  
  RESULTS
  Among a total of 825 patients, 100 patients (12%) were transferred from the neighbor islands. Among the neighbor-island patients, 69 patients (69%) did not receive SNP, which translates to $1035000 of excess cost over an 8-year period (approximately $129375/y). Multivariable analyses showed age (odds ratio [OR], 0.95; 95% confidence interval [CI]: 0.94-0.96), lack of hypertension (OR, 1.62; 95% CI: 1.002-2.61), initial Glasgow Coma Scale (OR, 0.94; 95% CI: 0.89-0.98), lobar hemorrhage (OR, 2.74; 95% CI: 1.59-4.71), cerebellar hemorrhage (OR, 5.47; 95% CI: 2.78-10.76), primary intraventricular hemorrhage (OR, 4.40; 95% CI: 1.77-10.94), and any intraventricular hemorrhage (OR, 2.47l 95% CI: 1.53-3.97) to be independent predictors of receiving SNP.
  
  
  CONCLUSIONS
  Approximately two-thirds of ICH patients who were air transferred did not receive SNP. Further study is needed to assess the cost-effectiveness of creating a triage algorithm to optimally select ICH patients who would benefit from air transport to a higher-level facility.
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI, USA; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA. Electronic address: kazuma.nakagawa@hawaii.edu.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Galati
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo, HI, USA.
authors.forename: Deborah Taira
authors.initials: DT
authors.lastname: Juarez
mesh_terms: D017732:Air Ambulances / Q000191:economics*; D002543:Cerebral Hemorrhage / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006254:Hawaii; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D010360:Patient Transfer / Q000191:economics*; D012189:Retrospective Studies