Length of Hospital Stay, Hospitalization Costs, and Their Drivers in Adults with Diabetes in the Romanian Public Hospital System

Abstract

The aim of this analysis was to assess the costs associated with the hospitalizations of persons with diabetes in a Romanian public hospital. We performed a retrospective “top-down” cost analysis of all adult patients discharged from a tertiary care hospital with an ICD-10 primary or secondary code of diabetes mellitus (type 1, type 2, or specific forms) between 1 January 2015 and 31 December 2018. All costs were adjusted with the annual inflation rates and converted to EUR. We included 16,868 patients with diabetes and 28,055 episodes of hospitalization. The total adjusted hospitalization cost in the analyzed period was EUR 26,418,126.8 and the adjusted median cost/episode of hospitalization was EUR 596.5. The mean length of a hospital stay/episode was 7.3 days. In the multivariate regression analysis, higher adjusted average costs/episodes of hospitalization and longer lengths of hospital stays were associated with increasing age, the presence of cardiovascular diseases, chronic kidney disease, and foot ulcerations. Moreover, a significant association between the average cost/episode of hospitalization and the length of hospital stay was observed (β = 0.704, p < 0.001). This study shows the burden on Romanian public hospitals of inpatient diabetes care and the main drivers of the costs.

Factors Influencing Hospitalization Cost for Diabetic Patients in Traditional Chinese Medicine Hospitals in Qingyang City, China

“…If the influence of the nature of the hospital on the hospitalization cost for diabetic patients was ignored, and only the influence of the diabetes patient’s situation on the hospitalization cost was considered, then the hospitalization cost of diabetic patients in a Chinese medicine hospital was mainly related to the length of stay, the type of diabetes, and the complications associated with comorbidities. In this case, the number of days in hospital was the strongest factor affecting hospitalization cost, which was consistent with the findings of Sima, D.I., Bala, C. et al [ 23 , 24 ].…”

Internações por Diabetes Mellitus em Roraima, Brasil

“…Sabe-se que a necessidade de mais tempo de hospitalização é um dos principais geradores de custos em indivíduos com DM, sendo mais longo em indivíduos que apresentam complicações crônicas 4 .…”

“…Observa-se que muitos indivíduos com DM poderiam ser tratados nos serviços ambulatoriais. Entretanto, a eficiência do tratamento depende da adesão terapêutica, do monitoramento regular da glicemia, do controle da dieta e da adoção de estilo de vida mais saudável 22. A maioria das complicações do DM poderia ser prevenida se estratégias de manejo e modificação dos riscos fossem planejadas 4 .…”

“…O Diabetes Mellitus (DM) é uma condição crônica complexa que requer acompanhamento médico contínuo, gerando desafios nos sistemas de saúde e impactos socioeconômicos de uma sociedade 2,3 . A prevalência do DM na população mundial é cerca de 10,5%, sendo que nas últimas décadas observou -se um aumento dos casos em torno de quatro vezes 3,4 . Nas Américas, o DM já representa a sexta causa de morte e a segunda causa de incapacidade 5,6 .…”

“…Devido a tendência mundial de aumento dos casos do DM, espera-se um acréscimo adicional da demanda pelos serviços de saúde 14 . A presença do DM geralmente requer maior tempo de hospitalização, independente do motivo primário da internação 4,16 . Sabe-se que o DM tipo 2 está associado com o aumento do risco para doenças cardiovasculares e que no geral, indivíduos com DM apresentam menor expectativa de vida 17 .…”