Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia

Deborah Hwang, Joan Teno, Pedro Gozalo, Susan Mitchell

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Context The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs. Objectives To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization. Methods Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design. Results Matched residents with (n = 1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference = 0.34, 0.92 days). Conclusion In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.

Original languageEnglish (US)
Pages (from-to)1116-1120
Number of pages5
JournalJournal of Pain and Symptom Management
Volume47
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Enteral Nutrition
Nursing Homes
Gastrostomy
Health Care Costs
Dementia
Medicare
Inpatients
Intensive Care Units
Costs and Cost Analysis
Mortality
Selection Bias
Hospital Costs
African Americans
Hospitalization

Keywords

  • advanced dementia
  • Feeding tubes
  • health care costs

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia. / Hwang, Deborah; Teno, Joan; Gozalo, Pedro; Mitchell, Susan.

In: Journal of Pain and Symptom Management, Vol. 47, No. 6, 01.01.2014, p. 1116-1120.

Research output: Contribution to journalArticle

Hwang, Deborah ; Teno, Joan ; Gozalo, Pedro ; Mitchell, Susan. / Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia. In: Journal of Pain and Symptom Management. 2014 ; Vol. 47, No. 6. pp. 1116-1120.
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abstract = "Context The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs. Objectives To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization. Methods Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design. Results Matched residents with (n = 1924, 68.9{\%} female, 28.8{\%} African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9{\%} 180 day mortality among those with a feeding tube vs. 49.8{\%} among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95{\%} CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95{\%} CI of difference = 0.34, 0.92 days). Conclusion In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.",
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AB - Context The best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs. Objectives To estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization. Methods Medicare claims (1999-2009) and Minimum Data Set data (1999-2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design. Results Matched residents with (n = 1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference = 0.34, 0.92 days). Conclusion In an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.

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