The Direct Medical Costs Associated with Suspected and Confirmed Cases of Heparin-Induced Thrombocytopenia.
Bibliographic record
Abstract
Abstract Introduction: Heparin-induced thrombocytopenia (HIT) is a serious adverse reaction associated with heparin exposure. Few studies have assessed the economic burden associated with HIT and none have assessed the costs of suspected HIT. The objective of our study was to identify and quantify the direct medical costs associated with suspected and confirmed cases of HIT from the Canadian hospital perspective. Methods: Over the last 7 years SHSC, a tertiary care adult academic hospital, experienced on average 125 cases of suspected HIT per year. A retrospective burden of illness analysis was conducted to examine the costs associated with suspected and confirmed cases of HIT at SHSC in 2005. Suspected HIT was defined by the performance of a HIT enzyme linked immunosorbent assay (ELISA) from January 1, 2005 to December 31, 2005. Confirmed HIT cases were defined as those who had a positive serotonin release assay (SRA) or a positive HIT ELISA plus a high clinical probability for HIT. In addition, HIT-related resource utilization variables were assessed by chart review and included: inpatient medication use; laboratory and imaging tests; and duration of hospital stay. Physician visits and post-discharge costs were not included in the cost analysis. The average cost per case of confirmed HIT, confirmed HIT with thrombosis (HITT), and negative HIT was calculated in 2007 Canadian dollars. Cost information was obtained from multiple sources, including the pharmacy database (WORx©) and Ontario Health Insurance Program (OHIP) Schedule of Benefits. For this analysis, we did not assume that length of stay (LOS) was prolonged by HIT unless the patient was readmitted with a HIT-related complication. The costs attributable to prolongation of LOS due to HIT or its treatment are being determined, although it is difficult to allocate some costs to the presence of HIT alone. The cost for a negative HIT case only includes the cost of inpatient medication use, laboratory and imaging tests. Results: There were 110 suspected HIT cases in 2005. We excluded 2 patients because their HIT status could not be determined after careful review. There were 88 HIT negative cases, 8 cases with confirmed HIT and 12 with HITT (Table). In this conservative analysis, patients with HITT incurred substantially greater costs than those with HIT. The average attributable cost of managing a HIT negative case was $116. Cardiovascular surgery (CVS) patients accounted for 48% of the suspected HIT cases and 65% of the confirmed cases. This represents 5% and 1% of the 960 CVS patients seen over the year. Conclusions: This is the first study to identify and quantify the direct medical costs associated both with confirmed HIT and HITT and also negative HIT cases. Clearly, if LOS is prolonged by HIT, as has been shown by others, the costs per case will escalate. Cardiovascular surgery cases are being analyzed separately. Table. Demographics and Incremental Costs for Suspected HIT Cases (n=108) Negative HIT Confirmed HIT Confirmed HITT n 88 8 12 CVS patients (%) 44% 75% 58% Other Surgical patients (%) 16% 13% 8% Medical patients (%) 40% 12% 34% Mean Age ± SD (range) 69 ± 13 (19–94) 64 ± 12 (47–83) 73 ± 7 (59–83) LOS ± SD (range) 37 ± 44 (3–244) 29 ± 21 (5–62) 37 ± 35 (12–128) Average HIT-attributable Cost per Case $116 $966 $6,762
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".