HEART ATTACKS: Lengthy Hospital Stays Not Cost-Effective
Prolonging hospital stays beyond three days for heart attack patients without complications is not cost-effective, according to a cost-benefit analysis published in today's New England Journal of Medicine. The study says hospitals could safely move toward discharging those patients after 72 hours. Researchers estimated that an extra day of monitored hospitalization for heart attack patients increased life expectancy, on average, by only about two days. At an incremental cost of $624 for the additional day of hospitalization, the cost-effectiveness ratio was calculated to be $105,629 per year of life saved -- double the "economically attractive threshold" of less than $50,000 per year of life saved, according to the study. To perform the analysis, researchers evaluated the rate of preventable cardiac deaths on the fourth day after thrombolysis for acute myocardial infarction (MI) among 22,361 patients who had experienced no complications during the first three days of hospitalization; 13 experienced no complications during the additional 24 hours. The authors conclude that prolonging hospitalization for patients like those included in the study is "economically unattractive" as compared to other clinical strategies for treatment of MI, such as angioplasty.
Not Universally Accepted
Authors caution, however, that further study is needed to ensure that long term outcomes are not compromised and that their findings may not apply to all MI patients. They also note that providing all the necessary testing, education and rehabilitation in three days before discharge would require rearrangement of care practices at most hospitals (Newby et al, 3/16). An accompanying editorial questions the study's conclusions, arguing that there is no "universally accepted threshold" for deciding when a treatment is cost-effective and pointing out that other factors, such as patients' emotional readiness for discharge and subsequent quality of life, should be considered. The editorial warns that the study's findings must not be used by health plans to deny claims for hospital stays longer than 72 hours, and urges physicians to use their own discretion in making discharge decisions (Antman/Kuntz, NEJM, 3/16).