Financial Implications of Early Hospital Discharge After AML-Like Induction Chemotherapy: A 4-Year Retrospective Analysis

Authors:
Nathan J. Moore Department of Medicine, Residency Program, University of Washington,

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 MD
,
Megan Othus Public Health Sciences Division, Fred Hutchinson Cancer Research Center,

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 PhD
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Anna B. Halpern Department of Medicine, Division of Hematology, University of Washington,
Clinical Research Division, Fred Hutchinson Cancer Research Center, and

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Nicholas P. Howard Clinical Research Division, Fred Hutchinson Cancer Research Center, and

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Linyi Tang Seattle Cancer Care Alliance, Seattle, Washington;

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 MS
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Kyle E. Bastys Seattle Cancer Care Alliance, Seattle, Washington;

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 MPH
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Mary-Elizabeth M. Percival Department of Medicine, Division of Hematology, University of Washington,
Clinical Research Division, Fred Hutchinson Cancer Research Center, and

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 MD, MS
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Paul C. Hendrie Department of Medicine, Division of Hematology, University of Washington,
Seattle Cancer Care Alliance, Seattle, Washington;

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 MD, PhD
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Garrett A. Hartley Pfizer Inc., New York, New York; and

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 MBA, MPH
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Verna L. Welch Pfizer Inc., New York, New York; and

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Elihu H. Estey Department of Medicine, Division of Hematology, University of Washington,
Clinical Research Division, Fred Hutchinson Cancer Research Center, and

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Roland B. Walter Department of Medicine, Division of Hematology, University of Washington,
Clinical Research Division, Fred Hutchinson Cancer Research Center, and
Department of Laboratory Medicine and Pathology, and
Department of Epidemiology, University of Washington, Seattle, Washington.

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 MD, PhD, MS
Volume/Issue:
Volume 19: Issue 13
Online Publication Date:
22 Jun 2021
DOI:
https://doi.org/10.6004/jnccn.2020.7683
Restricted access

Background: Early hospital discharge (EHD) after intensive acute myeloid leukemia (AML) induction chemotherapy has become routine at the University of Washington/Seattle Cancer Care Alliance over the past several years. We assessed the financial implications of EHD over the first 4 years after its broad adoption for patients with AML and other high-grade myeloid neoplasms undergoing AML-like induction chemotherapy. Patients and Methods: We retrospectively compared charges between 189 patients with EHD who received all postinduction inpatient/outpatient care within our care system between August 2014 and July 2018 and 139 medically matched control patients who remained hospitalized for logistical reasons. Charges from the day of initial discharge (patients with EHD) or end of chemotherapy (control patients) until blood count recovery, additional chemotherapy or care transition, hospital discharge (for control patients only), an elapse of 42 days, or death were extracted from financial databases and separated into categories: facility/provider, emergency department, transfusions, laboratory, imaging, pharmacy, and miscellaneous. Results: Combined charges averaged $4,157/day (range, $905–$13,119/day) for patients with EHD versus $9,248/day (range, $4,363–$48,522/day) for control patients (P<.001). The EHD cohort had lower mean facility/provider, transfusion, laboratory, and pharmacy charges but not imaging or miscellaneous charges. During readmissions, there was no statistically significant difference in daily inpatient charges between the EHD and control cohorts. After multivariable adjustment, average charges were $3,837/day lower for patients with EHD (P<.001). Conclusions: Together with previous data from our center showing that EHD is safe and associated with reduced healthcare resource utilization, this study further supports this care approach for AML and other high-grade myeloid neoplasms if infrastructure is available to enable close outpatient follow-up.

Submitted August 27, 2020; accepted for publication November 3, 2020. Published online June 22, 2021.

Author contributions: Study concept and design: Moore, Halpern, Walter. Data acquisition: Moore, Halpern, Howard, Tang, Bastys. Statistical analysis: Othus. Analysis and interpretation of results: Moore, Othus, Halpern, Walter. Manuscript preparation: Moore, Othus, Halpern, Walter. Critical review and edit of final draft: All authors. Project supervision: Halpern, Walter.

Disclosures: Drs. Hartley and Welch have disclosed employment at and equity ownership in Pfizer. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Disclaimer: R.B. Walter had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

Funding: Research reported in this publication was supported by a sponsored research agreement with Pfizer, Inc., and a University of Washington Department of Medicine Quality and Safety Accelerator Grant (both to R.B. Walter).

Correspondence: Roland B. Walter, MD, PhD, MS, Clinical Research Division, Fred Hutchinson Cancer Research Center/University of Washington, 1100 Fairview Avenue North, D2-190, Seattle, WA 98109-1024. Email: rwalter@fredhutch.org

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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2021 by the National Comprehensive Cancer Network 2021
Page Numbers:
10
Article Category:
Research Article
Received:
27 Aug 2020
Accepted:
03 Nov 2020
Print Publication Date:
01 Mar 2021
Online Publication Date:
22 Jun 2021

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