Health Care Expenditures of Medicare Beneficiaries with Normal Pressure Hydrocephalus

Phoebe Sharkey, Gabriel Pinilla Monsalve, Alessandra Rigamonti, Kathryn Anne Carson, Jamie Robison, Tito Vivas-Buitrago, Ignacio Jusué-Torres, Gwendolyn Dawn Clemens, Abanti Sanyal, Jamie Hoffberger, Eric W. Sankey, Jennifer Lu, Atif Adams, Daniele Rigamonti

Research output: Contribution to journalArticle

Abstract

Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the rate of treatment has increased, and if surgical treatment costs and socioeconomic factors related to receipt of treatment have changed over time compared with conservative therapy. Methods: A retrospective study based on data from a nationally representative random sample of 2,378,637 Medicare beneficiaries (2006–2010) was performed. Shunt surgery, shunt revision, replacement, and removal were analyzed as independent variables. Results: A total of 2321 patients with NPH were included, with 580 (24.99%) receiving a first shunt procedure. The adjusted effect of the procedure is that total 5-year expenditures are $11,676 more per patient (P < 0.001) than expenditures associated with nonsurgical management. Shunt revision ($22,715, P < 0.01) and/or replacement ($46,607, P < 0.001) add significantly to 5-year expenditures. Socioeconomic factors including African American race (P = 0.006); age 75–79 years (P = 0.024), 80–84 years (P < 0.001), and ≥85 years (P < 0.001); and Medicaid (P < 0.001) have significant negative associations with shunt surgery. Conclusions: There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12% in 1999 to 0.2% in 2008. The total costs per surgical patient rose by approximately 145% to 160% comparing 2001 and 2010. This increase was mainly due to hospital (by 167% to 168%) and home health costs (by 118% to 148%). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Normal Pressure Hydrocephalus
Health Expenditures
Medicare
Delivery of Health Care
Health Care Costs
Costs and Cost Analysis
Medicaid
Reoperation
African Americans
Retrospective Studies
Therapeutics
Population
Conservative Treatment

Keywords

  • Health expenditures
  • Medicare
  • Normal pressure hydrocephalus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Health Care Expenditures of Medicare Beneficiaries with Normal Pressure Hydrocephalus. / Sharkey, Phoebe; Monsalve, Gabriel Pinilla; Rigamonti, Alessandra; Carson, Kathryn Anne; Robison, Jamie; Vivas-Buitrago, Tito; Jusué-Torres, Ignacio; Clemens, Gwendolyn Dawn; Sanyal, Abanti; Hoffberger, Jamie; Sankey, Eric W.; Lu, Jennifer; Adams, Atif; Rigamonti, Daniele.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Sharkey, P, Monsalve, GP, Rigamonti, A, Carson, KA, Robison, J, Vivas-Buitrago, T, Jusué-Torres, I, Clemens, GD, Sanyal, A, Hoffberger, J, Sankey, EW, Lu, J, Adams, A & Rigamonti, D 2019, 'Health Care Expenditures of Medicare Beneficiaries with Normal Pressure Hydrocephalus', World neurosurgery. https://doi.org/10.1016/j.wneu.2019.03.201
Sharkey, Phoebe ; Monsalve, Gabriel Pinilla ; Rigamonti, Alessandra ; Carson, Kathryn Anne ; Robison, Jamie ; Vivas-Buitrago, Tito ; Jusué-Torres, Ignacio ; Clemens, Gwendolyn Dawn ; Sanyal, Abanti ; Hoffberger, Jamie ; Sankey, Eric W. ; Lu, Jennifer ; Adams, Atif ; Rigamonti, Daniele. / Health Care Expenditures of Medicare Beneficiaries with Normal Pressure Hydrocephalus. In: World neurosurgery. 2019.
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abstract = "Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the rate of treatment has increased, and if surgical treatment costs and socioeconomic factors related to receipt of treatment have changed over time compared with conservative therapy. Methods: A retrospective study based on data from a nationally representative random sample of 2,378,637 Medicare beneficiaries (2006–2010) was performed. Shunt surgery, shunt revision, replacement, and removal were analyzed as independent variables. Results: A total of 2321 patients with NPH were included, with 580 (24.99{\%}) receiving a first shunt procedure. The adjusted effect of the procedure is that total 5-year expenditures are $11,676 more per patient (P < 0.001) than expenditures associated with nonsurgical management. Shunt revision ($22,715, P < 0.01) and/or replacement ($46,607, P < 0.001) add significantly to 5-year expenditures. Socioeconomic factors including African American race (P = 0.006); age 75–79 years (P = 0.024), 80–84 years (P < 0.001), and ≥85 years (P < 0.001); and Medicaid (P < 0.001) have significant negative associations with shunt surgery. Conclusions: There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12{\%} in 1999 to 0.2{\%} in 2008. The total costs per surgical patient rose by approximately 145{\%} to 160{\%} comparing 2001 and 2010. This increase was mainly due to hospital (by 167{\%} to 168{\%}) and home health costs (by 118{\%} to 148{\%}). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.",
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AU - Monsalve, Gabriel Pinilla

AU - Rigamonti, Alessandra

AU - Carson, Kathryn Anne

AU - Robison, Jamie

AU - Vivas-Buitrago, Tito

AU - Jusué-Torres, Ignacio

AU - Clemens, Gwendolyn Dawn

AU - Sanyal, Abanti

AU - Hoffberger, Jamie

AU - Sankey, Eric W.

AU - Lu, Jennifer

AU - Adams, Atif

AU - Rigamonti, Daniele

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N2 - Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the rate of treatment has increased, and if surgical treatment costs and socioeconomic factors related to receipt of treatment have changed over time compared with conservative therapy. Methods: A retrospective study based on data from a nationally representative random sample of 2,378,637 Medicare beneficiaries (2006–2010) was performed. Shunt surgery, shunt revision, replacement, and removal were analyzed as independent variables. Results: A total of 2321 patients with NPH were included, with 580 (24.99%) receiving a first shunt procedure. The adjusted effect of the procedure is that total 5-year expenditures are $11,676 more per patient (P < 0.001) than expenditures associated with nonsurgical management. Shunt revision ($22,715, P < 0.01) and/or replacement ($46,607, P < 0.001) add significantly to 5-year expenditures. Socioeconomic factors including African American race (P = 0.006); age 75–79 years (P = 0.024), 80–84 years (P < 0.001), and ≥85 years (P < 0.001); and Medicaid (P < 0.001) have significant negative associations with shunt surgery. Conclusions: There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12% in 1999 to 0.2% in 2008. The total costs per surgical patient rose by approximately 145% to 160% comparing 2001 and 2010. This increase was mainly due to hospital (by 167% to 168%) and home health costs (by 118% to 148%). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.

AB - Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the rate of treatment has increased, and if surgical treatment costs and socioeconomic factors related to receipt of treatment have changed over time compared with conservative therapy. Methods: A retrospective study based on data from a nationally representative random sample of 2,378,637 Medicare beneficiaries (2006–2010) was performed. Shunt surgery, shunt revision, replacement, and removal were analyzed as independent variables. Results: A total of 2321 patients with NPH were included, with 580 (24.99%) receiving a first shunt procedure. The adjusted effect of the procedure is that total 5-year expenditures are $11,676 more per patient (P < 0.001) than expenditures associated with nonsurgical management. Shunt revision ($22,715, P < 0.01) and/or replacement ($46,607, P < 0.001) add significantly to 5-year expenditures. Socioeconomic factors including African American race (P = 0.006); age 75–79 years (P = 0.024), 80–84 years (P < 0.001), and ≥85 years (P < 0.001); and Medicaid (P < 0.001) have significant negative associations with shunt surgery. Conclusions: There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12% in 1999 to 0.2% in 2008. The total costs per surgical patient rose by approximately 145% to 160% comparing 2001 and 2010. This increase was mainly due to hospital (by 167% to 168%) and home health costs (by 118% to 148%). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.

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KW - Normal pressure hydrocephalus

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