A golden opportunity
In the current issue of the Journal, Allareddy et al.1 report on the prevalence of acute respiratory failure from any cause in hospitalized SCT patients and the associated hospital costs. The authors utilized the Nationwide Inpatient Sample (NIS), which is the largest all-payer inpatient database in the United States, approximating 97% of all hospital discharges annually. This study provides valuable information from one of the largest cohorts of patients (n=6074) hospitalized with respiratory failure following SCT. The authors confirm the well-documented finding that SCT recipients who develop respiratory failure have high in-hospital mortality.2,3 They found that the prevalence of respiratory failure increased over the course of the study. They also demonstrated that the overall in-hospital mortality was greater than 50% and that continuous invasive mechanical ventilation (IMV) and prolonged IMV (>96 h) were independent predictors of mortality. The novelty of the authors’ work is the assignment of a direct financial cost to hospital resource utilization associated with respiratory failure following SCT. The mean hospitalization charge was $620 765; total hospitalization expenditures for the entire cohort were a staggering $3.34 billion dollars. These costs did not include certain medications or loss of productivity and other indirect expenses associated with the hospitalizations and, therefore, likely underestimate true resource utilization.