Waimei Tai, MD

Specogna et al did an interesting analysis of a large cohort of intracranial hemorrhage (ICH) patients in one large tertiary care facility in Calgary, Alberta Canada. The demonstrated using administrative database in their single payer system that the median cost of an was about $USD 10,500 in 2008 adjusted dollars. There was a wide range (no surprise). What was interesting was that higher patient age and in-hospital mortality lowered the cost of the hospitalization. This is different that ischemic stroke data that suggests in-hospital mortality would likely increase the cost of hospital care. Perhaps this is due to the generally more medically sick ICH patients and a shorter length of stay associated with in-hospital mortality that contributes significantly to hospitalization costs.

A higher Charlson Comorbidity Index and having surgery for ICH also increased the acute care costs (no surprise).

Over all this study is useful in better understanding contributors to the cost of acute care in a single payer economy such as Alberta to develop predictive tools to help forecast expeditures. The medical drivers of cost are predictable. I think this case study should serve as an example to other payer/hospital systems to also critically look at drivers of cost of acute care as the quality/cost debate continues to grow as regulators in the U.S are looking to reimburse using value metrics. Better understanding who the drivers are allows us to selectively provide care that is most appropriate and cost effective. Hopefully the data on ICH surgery will provide more selection criteria to identify the best surgical candidates to offer this expensive intervention to.