TY - JOUR
T1 - Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia
AU - Hwang, Deborah
AU - Teno, Joan M.
AU - Gozalo, Pedro
AU - Mitchell, Susan
N1 - Funding Information:
These projects, “Effectiveness of Feeding Tubes Among Persons with Advanced Cognitive Impairment” and “Feeding Tube Use Among Persons with Advanced Dementia,” were funded by grants 1RC1AG036418-01 and RO1 AG024265 from the National Institutes of Health , National Institute of Aging , and U.S. Department of Health & Human Services , to principal investigator J. M. Teno, MD, MS. The authors declare no conflicts of interest.
PY - 2014/6
Y1 - 2014/6
N2 - 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.
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.
KW - Feeding tubes
KW - advanced dementia
KW - health care costs
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U2 - 10.1016/j.jpainsymman.2013.08.007
DO - 10.1016/j.jpainsymman.2013.08.007
M3 - Article
C2 - 24112820
AN - SCOPUS:84902495770
SN - 0885-3924
VL - 47
SP - 1116
EP - 1120
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -