{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T07:55:03Z","timestamp":1768031703705,"version":"3.49.0"},"reference-count":54,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T00:00:00Z","timestamp":1670976000000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012781","name":"MSD K. K., Tokyo, Japan","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100012781","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,11,7]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Delirium is a neuropsychiatric disorder that commonly occurs in elderly patients with cognitive impairment. The economic burden of delirium in Japan has not been well characterised. In this study, we assessed incremental medical costs of delirium in hospitalised elderly Japanese patients with cognitive impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, cross-sectional, observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Administrative data collected from acute care hospitals in Japan between April 2012 and September 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Hospitalised patients \u226565 years old with cognitive impairment were categorised into groups\u2014with and without delirium. Delirium was identified using a delirium identification algorithm based on the International Classification of Diseases 10\n                      <jats:sup>th<\/jats:sup>\n                      Revision codes or antipsychotic prescriptions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Total medical costs during hospitalisation were compared between the groups using a generalised linear model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study identified 297 600 hospitalised patients \u226565 years of age with cognitive impairment: 39 836 had delirium and 257 764 did not. Patient characteristics such as age, sex, inpatient department and comorbidities were similar between groups. Mean (SD) unadjusted total medical cost during hospitalisation was 979 907.7 (871 366.4) yen for patients with delirium and 816 137.0 (794 745.9) yen for patients without delirium. Adjusted total medical cost was significantly greater for patients with delirium compared with those without delirium (cost ratio=1.09, 95% CI: 1.09 to 1.10; p&lt;0.001). Subgroup analyses revealed significantly higher total medical costs for patients with delirium compared with those without delirium in most subgroups except patients with hemiplegia or paraplegia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical costs during hospitalisation were significantly higher for patients with delirium compared with those without delirium in elderly Japanese patients with cognitive impairment, regardless of patient subgroups such as age, sex, intensive care unit admission and most comorbidities. These findings suggest that delirium prevention strategies are critical to reducing the economic burden as well as psychological\/physiological burden in cognitively impaired elderly patients in Japan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-062141","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T12:14:08Z","timestamp":1671106448000},"page":"e062141","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Incremental medical cost of delirium in elderly patients with cognitive impairment: analysis of a nationwide administrative database in Japan"],"prefix":"10.1136","volume":"12","author":[{"given":"Masakazu","family":"Igarashi","sequence":"first","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kotoba","family":"Okuyama","sequence":"additional","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoya","family":"Ueda","sequence":"additional","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Sano","sequence":"additional","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanae","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Japan Development, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaina","family":"P Qureshi","sequence":"additional","affiliation":[{"name":"Center for Observational and Real-world Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Tokita","sequence":"additional","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asao","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuyuki","family":"Okumura","sequence":"additional","affiliation":[{"name":"Initiative for Clinical Epidemiological Research, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-2602","authenticated-orcid":false,"given":"Shoki","family":"Okuda","sequence":"additional","affiliation":[{"name":"Medical Affairs, MSD KK, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"2025121409341003000_12.12.e062141.1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.08020181"},{"key":"2025121409341003000_12.12.e062141.2","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.cger.2019.11.001","article-title":"Delirium in the elderly","volume":"36","author":"Hshieh","year":"2020","journal-title":"Clin Geriatr Med"},{"key":"2025121409341003000_12.12.e062141.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.12067"},{"key":"2025121409341003000_12.12.e062141.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60688-1"},{"key":"2025121409341003000_12.12.e062141.5","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl005"},{"key":"2025121409341003000_12.12.e062141.6","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3390\/nursrep11010016","article-title":"Nurses' experience of caring for patients with delirium: systematic review and qualitative evidence synthesis","volume":"11","author":"Thomas","year":"2021","journal-title":"Nurs Rep"},{"key":"2025121409341003000_12.12.e062141.7","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.1111\/j.1365-2702.2012.04130.x","article-title":"A quantitative exploration of the subjective burden experienced by nurses when caring for patients with delirium","volume":"21","author":"McDonnell","year":"2012","journal-title":"J Clin Nurs"},{"key":"2025121409341003000_12.12.e062141.8","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnx153"},{"key":"2025121409341003000_12.12.e062141.9","first-page":"575","article-title":"Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study","volume":"165","author":"McCusker","year":"2001","journal-title":"CMAJ"},{"key":"2025121409341003000_12.12.e062141.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.14.1753"},{"key":"2025121409341003000_12.12.e062141.11","doi-asserted-by":"publisher","DOI":"10.1186\/cc3729"},{"key":"2025121409341003000_12.12.e062141.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2011.11.016"},{"key":"2025121409341003000_12.12.e062141.13","first-page":"1132","article-title":"Incremental cost and length of stay associated with postprocedure delirium in transcatheter and surgical aortic valve replacement patients in the United States","volume":"93","author":"Potter","year":"2019","journal-title":"Catheter Cardiovasc Interv"},{"key":"2025121409341003000_12.12.e062141.14","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00101-5"},{"key":"2025121409341003000_12.12.e062141.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra052321"},{"key":"2025121409341003000_12.12.e062141.16","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181a4129a"},{"key":"2025121409341003000_12.12.e062141.17","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3203"},{"key":"2025121409341003000_12.12.e062141.18","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/60.6.748"},{"key":"2025121409341003000_12.12.e062141.19","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.8931","article-title":"Economic burden of postoperative neurocognitive disorders among US Medicare patients","volume":"3","author":"Boone","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025121409341003000_12.12.e062141.20","unstructured":"Statistics of Bureau, Ministry of Internal Affairs and Communications . Population estimates by age (five-year groups) and sex, 2021. Available: https:\/\/www.e-stat.go.jp\/en\/stat-search\/file-download?statInfId=000032191044&fileKind=4 [Accessed 15 Apr 2022]."},{"key":"2025121409341003000_12.12.e062141.21","unstructured":"Summary of patient survey, Ministry of health and welfare (Japanese), 2017. Available: https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/kanja\/17\/index.html [Accessed 02 Feb 2022]."},{"key":"2025121409341003000_12.12.e062141.22","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1159\/000353444","article-title":"Prevalence of dementia in Japan: a systematic review","volume":"36","author":"Okamura","year":"2013","journal-title":"Dement Geriatr Cogn Disord"},{"key":"2025121409341003000_12.12.e062141.23","unstructured":"Medical data vision (MDV) database, 2022. Available: https:\/\/www.mdv.co.jp\/mdv_database\/english\/ [Accessed 02 Feb 2022]."},{"key":"2025121409341003000_12.12.e062141.24","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1111\/jgs.15282","article-title":"Dementia and risk of 30-day readmission in older adults after discharge from acute care hospitals","volume":"66","author":"Sakata","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"2025121409341003000_12.12.e062141.25","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4226"},{"key":"2025121409341003000_12.12.e062141.26","unstructured":"Committee on Treatment Strategy and Tactics . Clinical guideline for the treatment of delirium, 2nd edition (Japanese Society of General Hospital Psychiatry Practice Guidelines 1). Tokyo, Japan: Seiwa Shoten Publishers, 2015: 85\u2013111."},{"key":"2025121409341003000_12.12.e062141.27","first-page":"61","article-title":"Functional evaluation: the Barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md State Med J"},{"key":"2025121409341003000_12.12.e062141.28","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15767"},{"key":"2025121409341003000_12.12.e062141.29","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/ggi.12890","article-title":"Screening Tool for Older Persons' Appropriate Prescriptions for Japanese: Report of the Japan Geriatrics Society Working Group on \"Guidelines for medical treatment and its safety in the elderly\"","volume":"16","author":"Kojima","year":"2016","journal-title":"Geriatr Gerontol Int"},{"key":"2025121409341003000_12.12.e062141.30","first-page":"33","article-title":"Relationship between the onset of delirium during hospitalization and the use of high-risk drugs for delirium","volume":"1","author":"Noshiro","year":"2018","journal-title":"Med J Matsue City Hosp"},{"key":"2025121409341003000_12.12.e062141.31","unstructured":"Brand JPL . Development, implementation and evaluation of multiple imputation strategies for the statistical analysis of incomplete data sets, 1999. Available: https:\/\/repub.eur.nl\/pub\/19790\/990408_BRAND,%20Jacob%20Pieter%20Laurens.pdf [Accessed 02 Feb 2022]."},{"key":"2025121409341003000_12.12.e062141.32","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206074463"},{"key":"2025121409341003000_12.12.e062141.33","doi-asserted-by":"publisher","DOI":"10.1258\/1355819042250249"},{"key":"2025121409341003000_12.12.e062141.34","doi-asserted-by":"publisher","DOI":"10.1023\/A:1012597123667"},{"key":"2025121409341003000_12.12.e062141.35","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/alz.12262","article-title":"The economic cost of delirium: a systematic review and quality assessment","volume":"17","author":"Kinchin","year":"2021","journal-title":"Alzheimers Dement"},{"key":"2025121409341003000_12.12.e062141.36","doi-asserted-by":"crossref","first-page":"341.e15","DOI":"10.1016\/j.urolonc.2018.04.012","article-title":"A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries","volume":"36","author":"Ha","year":"2018","journal-title":"Urol Oncol"},{"key":"2025121409341003000_12.12.e062141.37","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.4"},{"key":"2025121409341003000_12.12.e062141.38","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0026951"},{"key":"2025121409341003000_12.12.e062141.39","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.14.1657"},{"key":"2025121409341003000_12.12.e062141.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.02762.x"},{"key":"2025121409341003000_12.12.e062141.41","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00134-021-06490-3","article-title":"Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis","volume":"47","author":"Burry","year":"2021","journal-title":"Intensive Care Med"},{"key":"2025121409341003000_12.12.e062141.42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199903043400901"},{"key":"2025121409341003000_12.12.e062141.43","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49108.x"},{"key":"2025121409341003000_12.12.e062141.44","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afi031"},{"key":"2025121409341003000_12.12.e062141.45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02485.x"},{"key":"2025121409341003000_12.12.e062141.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2018.06.007"},{"key":"2025121409341003000_12.12.e062141.47","first-page":"557","article-title":"Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial","volume":"27","author":"Ogawa","year":"2019","journal-title":"Support Care Cancer"},{"key":"2025121409341003000_12.12.e062141.48","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1001\/jamapsychiatry.2018.4365","article-title":"Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: a network meta-analysis","volume":"76","author":"Wu","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"2025121409341003000_12.12.e062141.49","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000021043","article-title":"Suvorexant for the prevention of delirium: a meta-analysis","volume":"99","author":"Xu","year":"2020","journal-title":"Medicine"},{"key":"2025121409341003000_12.12.e062141.50","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53156.x"},{"key":"2025121409341003000_12.12.e062141.51","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.03243.x"},{"key":"2025121409341003000_12.12.e062141.52","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-060630"},{"key":"2025121409341003000_12.12.e062141.53","first-page":"195","article-title":"Study on the risk factors for postoperative delirium using the National health insurance claims database in Japan","volume":"45","author":"Sakakibara","year":"2019","journal-title":"Iryo Yakugaku"},{"key":"2025121409341003000_12.12.e062141.54","first-page":"81","article-title":"Diagnosis procedure combination as an infrastructure for the clinical study","volume":"5","author":"Matsuda","year":"2011","journal-title":"Asian Pac J Dis Manage"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-062141","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:34:19Z","timestamp":1765733659000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-062141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":54,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,15]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bmjopen-2022-062141"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-062141","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}