Key result
Higher patient-level hospital spending for acute myocardial infarction was associated with a decreased hazard of dying (HR 0.700) when accounting for survivor-treatment bias.
Why the study?
Does higher patient-level hospital spending improve 1-year survival in first-time AMI patients when accounting for survivor-treatment selection bias?
Cohort (n=30,939)
Yes
Does higher patient-level hospital spending improve 1-year survival in first-time AMI patients when accounting for survivor-treatment selection bias?
Higher patient-level hospital spending for AMI is associated with improved 1-year survival, but failing to account for survivor-treatment bias overestimates this protective effect by 62%.
Answers are grounded in this paper and cite their sources.
Should not yet change AMI spending practices; leaves open causal effects for randomized confirmation.
OBJECTIVES: Previous patient-level acute myocardial infarction (AMI) research has found higher hospital spending to be associated with improved survival; however, survivor-treatment selection bias traditionally has been overlooked. The purpose of this study was to examine the AMI cost-outcome relationship, taking into account this form of bias. DATA SOURCES: Hospital Discharge Abstract data tracked costs for AMI hospitalizations. Ontario Vital Statistics data tracked patient mortality. STUDY DESIGN: A standard Cox survival model was compared to an extended Cox model using hospital costs as a time-varying covariate to examine the impact of cost on 1-year survival in a cohort of 30,939 first-time AMI patients in Ontario, Canada, from 2007 to 2010. PRINCIPAL FINDINGS: Higher patient-level AMI spending decreased the hazard of dying (Standard Model: log-cost hazard ratio: 0.513, 95 percent CI: 0.479-0.549; Extended Model: log-cost hazard ratio: 0.700, 95 percent CI: 0.645-0.758); however, the protective effect was overestimated by 62 percent when survivor-treatment bias was overlooked. In the extended model, a 10 percent increase in spending was associated with a 3.6 percent decrease in hazard of death. CONCLUSION: The findings of this study suggest that if survivor-treatment bias is overlooked, future research may materially overstate the protective effect of patient-level spending on outcomes.
No takes yet. Share an insight, caveat, or question.
Cohen et al. (2015) conducted a cohort in Acute myocardial infarction (n=30,939). Higher hospital spending vs. Lower hospital spending was evaluated on 1-year all-cause mortality (HR 0.700, 95% CI 0.645-0.758, p=<0.0001). Higher patient-level hospital spending for acute myocardial infarction was associated with a decreased hazard of dying (HR 0.700) when accounting for survivor-treatment bias.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: