Detailed analysis of in-hospital costs for adult patients with Type III intestinal failure: A single centre study with global implications.

BACKGROUND Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, due to its rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing management costs. This study aims to document the costs of type III IF within the hospital, from initial admission, including readmissions; and to compare incurred costs with current Government reimbursement. METHODS A retrospective study design reviewed costs and reimbursement for 25 consecutive patients commencing HPN at a quaternary hospital (October 2011-September 2017). Hospital admissions were separated into the initial hospital admission and readmission(s) period. Healthcare use and cost data were collected using electronic medical records including pathology, imaging, surgical procedures, staffing, and HPN. Hospital re-imbursement costs were retrieved from Sydney Local health district's Targeted Activity and Reporting Systems. Patient demographics were tabulated, and healthcare use and cost data compared using Wilcoxon signed rank tests. RESULTS The median cost of the initial hospital admission was substantially higher than the median reimbursement ($36,675; IQR 23,196-67439 vs $19,247; IQR 7485-41090, p < 0.001). Similar results were observed in the readmissions period, with median incurred costs of $13,898; IQR 11151-32130 vs reimbursement of $8,469; IQR 5,625-13,078, p = 0.001. CONCLUSION Results indicate that type III IF patients have high inpatient costs, which substantially outweigh current reimbursement. Improved funding models are needed to ensure hospitals that accept the management challenge of type III IF patients are not unduly penalized. This article is protected by copyright. All rights reserved.