As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable adva...As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1<sup>st</sup>-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.展开更多
Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored ...Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.展开更多
BACKGROUND The burden of carcinoid syndrome(CS)among patients with neuroendocrine tumors is substantial and has been shown to result in increased healthcare resource use and costs.The incremental burden of CS diarrhea...BACKGROUND The burden of carcinoid syndrome(CS)among patients with neuroendocrine tumors is substantial and has been shown to result in increased healthcare resource use and costs.The incremental burden of CS diarrhea(CSD)is less well understood,particularly among working age adults who make up a large proportion of the population of patients with CS.AIM To estimate the direct medical costs of CSD to a self-insured employer in the United States.METHODS CS patients with and without CSD were identified in the IBM®MarketScan®Database,including the Medicare Supplemental Coordination of Benefits database.Eligible patients had≥1 medical claim for CS with continuous health plan enrollment for≥12 mo prior to their first CS diagnosis and for≥30 d after,no claims for acromegaly,and no clinical trial participation during the study period(2014-2016).Baseline demographic and clinical characteristics,including comorbidities and treatment,were analyzed using descriptive statistics.Measures of healthcare resource use and costs were compared between patients with and without CSD,including Emergency Department(ED)visits,hospital admissions and length of stay,physician office visits,outpatient services,and prescription claims,using univariate and multivariate analyses to evaluate associations of CSD with healthcare resource use and costs,controlling for baseline characteristics.RESULTS Overall,6855 patients with CS were identified of which 4,043 were eligible for the analysis(1352 with CSD,2691 with CS only).Baseline demographic and clinical characteristics were similar between groups with the exception of age,underlying tumor type,and health insurance plan.Patients with CSD were older,had more comorbidities,and received more somatostatin analog therapy at baseline.Patients with CSD required greater use of healthcare resources and incurred higher costs than their peers without CSD,including hospitalizations(44%vs 25%)and ED visits(55%vs 31%).The total adjusted annual healthcare costs per patient were 50%higher(+$23865)among those with CSD,driven by outpatient services(+56%),prescriptions(+48%),ED visits(+26%),physician office visits(+21%),and hospital admissions(+11%).CONCLUSION The economic burden of CSD is greater than that of CS alone among insured working age adults in the United States,which may benefit from timely diagnosis and management.展开更多
Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalenc...Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalence of HF,as it is for most other chronic conditions.[2]This means that,with the predicted aging of the population(the proportion of the world’s population aged 60 years and over will nearly double from 2015 to 2050),[3]there will be a growth in the total burden of HF,and a rise in the number of comorbidities in HF patients.According to a recent study,almost 86%of adults with HF have two or more comorbid conditions.[4]Comorbidity,defined as the co-existence of one or more additional conditions in individuals with a specified index medical condition,[5]adds to the complexity of treating elderly patients with HF.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been give...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.展开更多
Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the co...Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.展开更多
We present a case of tubercular arthritis who underwent numerous unnecessary investigations what is known as "victims of modern imaging technology" or VOMIT. Today there is an exponential rise in the volume ...We present a case of tubercular arthritis who underwent numerous unnecessary investigations what is known as "victims of modern imaging technology" or VOMIT. Today there is an exponential rise in the volume of the medical imaging, part of which is contributed by unnecessary and unjustified indications. We discuss about the untoward effects of the uninhibited and careless use of modern imaging modalities and possible ways to avoid. Skeletal manifestation of the tuberculosis is still common in the endemic countries like India. Although the final diagnosis of the skeletal tuberculosis like tubercular arthritis is made by bacteriological and histological studies, few demographic, clinical and radiological features might help making early diagnosis.展开更多
Background:India reports the highest number of tuberculosis(TB)cases worldwide.Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB.Our objective was ...Background:India reports the highest number of tuberculosis(TB)cases worldwide.Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB.Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar(western India)using an adapted World Health Organization costing tool.Methods:We conducted a descriptive cross-sectional study of adults,notified in the public sector and being treated for drug-susceptible pulmonary TB during January-June 2019,in six urban and three rural blocks of Bhavnagar region,Gujarat state,India.The direct and indirect TB-related costs,as well as patients’coping strategies,were assessed for the overall care of TB till treatment completion.Catastrophic costs were defined as total costs>20%of annual household income(excluding any amount received from cash transfer programs or borrowed).Median and interquartile range(IQR)was used to summarize patient costs.The median costs between any two groups were compared using the median test.The association between any two categorical variables was tested by the Pearson chi-squared test.All costs were described in US dollars(USD).During the study period,on average,one USD equalled 70 Indian Rupees.Results:Of 458 patients included,70%were male,62%had no formal education,71%lived in urban areas,and 96%completed TB treatment.The median(IQR)total costs were USD 8(5-28),direct medical costs were USD 0(0-0),direct non-medical costs were USD 3(2-4)and indirect costs were USD 6(3-13).Among direct non-medical costs,travel cost(median=USD 3,IQR:2-4)to attend health facilities were the most prominent,whereas the indirect costs were mainly contributed by the patient’s loss of wages(median=USD 3,IQR:0-6).Four percent of patients faced catastrophic costs,11%borrowed money to cover costs and 7%lost their employment;the median working days lost to TB was 30(IQR:15-45).A majority(88%)of patients received a median USD 43(IQR:41-43)as part of a cash transfer program for TB patients.Conclusions:Treatment completion was high and the costs incurred by TB patients were low in this setting.However,negative financial consequences occur even in low-cost settings.The role of universal cash transfer programs in such settings requires further study.展开更多
Background Fever of unknown origin(FUO)continues to challenge clinicians to determine an etiology and the need for treatment.This study explored the most common etiologies,characteristics,and average cost of hospitali...Background Fever of unknown origin(FUO)continues to challenge clinicians to determine an etiology and the need for treatment.This study explored the most common etiologies,characteristics,and average cost of hospitalization for FUO in a pediatric population at an urban,tertiary care hospital in Washington,DC.Methods Records from patients admitted to Children's National Health System between September 2008 and April 2014 with an admission ICD-9 code for fever(780.6)were reviewed.The charts of patients 2-18 years of age with no underlying diagnosis and a temperature greater than 38.3℃for 7 days or more at time of hospitalization were included.Final diagnoses,features of admission,and total hospital charges were abstracted.Results 110 patients qualified for this study.The majority of patients(n=42,38.2%)were discharged without a diagnosis.This was followed closely by infection,accounting for 37.2%(n=41)of patients.Rheumatologic disease was next(n=16,14.5%),followed by miscellaneous(n=6,5.4%)and oncologic diagnoses(n=5,4.5%).The average cost of hospitalization was 40,295 US dollars.Conclusions This study aligns with some of the most recent publications which report undiagnosed cases as the most common outcome in patients hospitalized with FUO.Understanding that,often no diagnosis is found may reassure patients,families,and clinicians.The cost associated with hospitalization for FUO may cause clinicians to reconsider inpatient admission for diagnostic work-up of fever,particularly given the evidence demonstrating that many patients are discharged without a diagnosis.展开更多
文摘As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1<sup>st</sup>-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.
基金This study was supported by the National Health and Medical Research Council(APP1145239).
文摘Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.
文摘BACKGROUND The burden of carcinoid syndrome(CS)among patients with neuroendocrine tumors is substantial and has been shown to result in increased healthcare resource use and costs.The incremental burden of CS diarrhea(CSD)is less well understood,particularly among working age adults who make up a large proportion of the population of patients with CS.AIM To estimate the direct medical costs of CSD to a self-insured employer in the United States.METHODS CS patients with and without CSD were identified in the IBM®MarketScan®Database,including the Medicare Supplemental Coordination of Benefits database.Eligible patients had≥1 medical claim for CS with continuous health plan enrollment for≥12 mo prior to their first CS diagnosis and for≥30 d after,no claims for acromegaly,and no clinical trial participation during the study period(2014-2016).Baseline demographic and clinical characteristics,including comorbidities and treatment,were analyzed using descriptive statistics.Measures of healthcare resource use and costs were compared between patients with and without CSD,including Emergency Department(ED)visits,hospital admissions and length of stay,physician office visits,outpatient services,and prescription claims,using univariate and multivariate analyses to evaluate associations of CSD with healthcare resource use and costs,controlling for baseline characteristics.RESULTS Overall,6855 patients with CS were identified of which 4,043 were eligible for the analysis(1352 with CSD,2691 with CS only).Baseline demographic and clinical characteristics were similar between groups with the exception of age,underlying tumor type,and health insurance plan.Patients with CSD were older,had more comorbidities,and received more somatostatin analog therapy at baseline.Patients with CSD required greater use of healthcare resources and incurred higher costs than their peers without CSD,including hospitalizations(44%vs 25%)and ED visits(55%vs 31%).The total adjusted annual healthcare costs per patient were 50%higher(+$23865)among those with CSD,driven by outpatient services(+56%),prescriptions(+48%),ED visits(+26%),physician office visits(+21%),and hospital admissions(+11%).CONCLUSION The economic burden of CSD is greater than that of CS alone among insured working age adults in the United States,which may benefit from timely diagnosis and management.
文摘Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalence of HF,as it is for most other chronic conditions.[2]This means that,with the predicted aging of the population(the proportion of the world’s population aged 60 years and over will nearly double from 2015 to 2050),[3]there will be a growth in the total burden of HF,and a rise in the number of comorbidities in HF patients.According to a recent study,almost 86%of adults with HF have two or more comorbid conditions.[4]Comorbidity,defined as the co-existence of one or more additional conditions in individuals with a specified index medical condition,[5]adds to the complexity of treating elderly patients with HF.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.
文摘Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.
文摘We present a case of tubercular arthritis who underwent numerous unnecessary investigations what is known as "victims of modern imaging technology" or VOMIT. Today there is an exponential rise in the volume of the medical imaging, part of which is contributed by unnecessary and unjustified indications. We discuss about the untoward effects of the uninhibited and careless use of modern imaging modalities and possible ways to avoid. Skeletal manifestation of the tuberculosis is still common in the endemic countries like India. Although the final diagnosis of the skeletal tuberculosis like tubercular arthritis is made by bacteriological and histological studies, few demographic, clinical and radiological features might help making early diagnosis.
文摘Background:India reports the highest number of tuberculosis(TB)cases worldwide.Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB.Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar(western India)using an adapted World Health Organization costing tool.Methods:We conducted a descriptive cross-sectional study of adults,notified in the public sector and being treated for drug-susceptible pulmonary TB during January-June 2019,in six urban and three rural blocks of Bhavnagar region,Gujarat state,India.The direct and indirect TB-related costs,as well as patients’coping strategies,were assessed for the overall care of TB till treatment completion.Catastrophic costs were defined as total costs>20%of annual household income(excluding any amount received from cash transfer programs or borrowed).Median and interquartile range(IQR)was used to summarize patient costs.The median costs between any two groups were compared using the median test.The association between any two categorical variables was tested by the Pearson chi-squared test.All costs were described in US dollars(USD).During the study period,on average,one USD equalled 70 Indian Rupees.Results:Of 458 patients included,70%were male,62%had no formal education,71%lived in urban areas,and 96%completed TB treatment.The median(IQR)total costs were USD 8(5-28),direct medical costs were USD 0(0-0),direct non-medical costs were USD 3(2-4)and indirect costs were USD 6(3-13).Among direct non-medical costs,travel cost(median=USD 3,IQR:2-4)to attend health facilities were the most prominent,whereas the indirect costs were mainly contributed by the patient’s loss of wages(median=USD 3,IQR:0-6).Four percent of patients faced catastrophic costs,11%borrowed money to cover costs and 7%lost their employment;the median working days lost to TB was 30(IQR:15-45).A majority(88%)of patients received a median USD 43(IQR:41-43)as part of a cash transfer program for TB patients.Conclusions:Treatment completion was high and the costs incurred by TB patients were low in this setting.However,negative financial consequences occur even in low-cost settings.The role of universal cash transfer programs in such settings requires further study.
文摘Background Fever of unknown origin(FUO)continues to challenge clinicians to determine an etiology and the need for treatment.This study explored the most common etiologies,characteristics,and average cost of hospitalization for FUO in a pediatric population at an urban,tertiary care hospital in Washington,DC.Methods Records from patients admitted to Children's National Health System between September 2008 and April 2014 with an admission ICD-9 code for fever(780.6)were reviewed.The charts of patients 2-18 years of age with no underlying diagnosis and a temperature greater than 38.3℃for 7 days or more at time of hospitalization were included.Final diagnoses,features of admission,and total hospital charges were abstracted.Results 110 patients qualified for this study.The majority of patients(n=42,38.2%)were discharged without a diagnosis.This was followed closely by infection,accounting for 37.2%(n=41)of patients.Rheumatologic disease was next(n=16,14.5%),followed by miscellaneous(n=6,5.4%)and oncologic diagnoses(n=5,4.5%).The average cost of hospitalization was 40,295 US dollars.Conclusions This study aligns with some of the most recent publications which report undiagnosed cases as the most common outcome in patients hospitalized with FUO.Understanding that,often no diagnosis is found may reassure patients,families,and clinicians.The cost associated with hospitalization for FUO may cause clinicians to reconsider inpatient admission for diagnostic work-up of fever,particularly given the evidence demonstrating that many patients are discharged without a diagnosis.
