PTU-148Healthcare Costs And Quality Of Life Associated With Acute Upper Gastrointestinal Bleeding In The Uk

IntroductionAcute upper gastrointestinal bleeding (AUGIB) accounts for over 70,000 hospital admissions in the UK annually. Its incidence is likely to rise due to an ageing population and increasing burden of liver disease. Data on the healthcare costs and health-related quality of life (HRQoL) associated with this condition are sparse.MethodsThe TRIGGER trial is a cluster randomised feasibility trial evaluating restrictive versus liberal red cell transfusion for patients with AUGIB. The study collected data on resource use, costs and outcomes during hospitalisation and up to day 28 to explore the feasibility of gathering inputs required for a cost-effectiveness analysis. Resource use data were collected during the inpatient episode on the use of laboratory tests, medications, blood components, endoscopy and endoscopic therapy, clinical events including ischaemic/thromboembolic events and length of hospital stay (LOS) by ward type. Data were also collected on primary and secondary care resource use, as well as informal care/days off work, post-discharge to day 28. Resource use for each patient was multiplied by national unit costs to generate an estimate of the costs of AUGIB to 28 days. HRQoL was measured on a scale anchored at 0 (death) and 1 (full health), using the EuroQol EQ-5D-3L questionnaire at day 28.Results936 patients were enrolled into TRIGGER between August 2012 and March 2013 in 6 UK hospitals. Preliminary analyses show that the mean (standard error (SE)) cost of the inpatient episode was pound sterling 1,914 ( pound sterling 78) per patient. LOS was a key cost driver; mean LOS was 5.4 days with an associated cost of pound sterling 1431. Additional cost drivers included: (1) red cell transfusion, with a mean of 1.6 units transfused per patient at a cost of pound sterling 197; (2) endoscopy, with mean of 0.8 endoscopies per patient at a cost of pound sterling 169. Mean (SE) costs from hospital discharge to 28 days were pound sterling 293 ( pound sterling 22) per patient. The main cost driver post discharge was readmission to hospital; 12% of patients were readmitted within 28 days for a mean of 4.8 days. The mean cost associated with readmission across all patients was pound sterling 127. HRQoL was on average (SE) 0.68 (0.01) at 28 days.ConclusionThe mean cost up to 28 days for patients presenting with AUGIB is pound sterling 2,207. At 28 days, the mean HRQoL in patients who have experienced an AUGIB is well below the average population level o