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National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014. Background: Recently emergency department (ED) utilization has been increasing for the management of acute conditions. Utilization of ED healthcare services by hematology and oncology patients have been documented previously. Cancer patients frequently visit the EDs with acute symptoms, that may require further assessment, management, and even hospitalization. Whether the incidence of leukemia related ED visits has altered is unknown. The aim of this study was to analyze the trend of leukemia related ED visits, healthcare cost associated with the visit and the discharge disposition from ED. Methods: We utilized Nationwide Emergency Department Sample (NEDS) dataset for this study. NEDS is a part of the Healthcare Cost and Utilization Project (HCUP) database and contains the information of more than 950 United States (US) hospitals that is weighted to the national estimates. We used five years of data from 2010 to 2014 to examine the trends in prevalence and rates of ED visits, cost, and disposition (such as admission, discharge and death in ED). We defined patients with leukemia (acute myeloid, chronic myeloid, acute lymphocytic, and chronic lymphocytic leukemias) by using the international classification of disease, 9th revision, clinical modification (ICD-9-CM) codes. Cochrane-Armitage test was used to assess the trend of leukemia ER visits over five years. We used estimated US census population to calculate the rate of leukemia related ED visits. Furthermore, we assessed the predictors of hospital admission by using multivariable logistic regression model. Results: Between 2010 to 2014, a nationally weighted estimate of 771,510 patients visited ED with leukemia. The frequency of leukemia related ED visits increased 21.7% from 138,038 to 167,935 during this period that accounted for 0.12% of all ED visits. The rate of leukemia related ED visits increased 20.5% from 44 to 53 per 100,000 census population, which was statistically significant (p=0.04) on a trend test. The total national cost of leukemia related visit increased by 81% from $544 million in 2010 to $984 million in 2014 (p-value0.05). In an adjusted multivariable logistic regression analysis, increasing age (OR 1.02 95% CI 1.024, 1.027), male gender (OR 1.15, 95% CI 1.114, 1.188), patient location in metropolitan area (OR 2.08, 95% CI 1.88, 2.22) and northeast location (OR 1.16, 95% CI 1.03, 1.32) were found to be significantly associated with the higher odds of in hospital admission following leukemia related ED visits. While few other variables like residents of higher income quartile and those holding Medicaid, insurance were also found to be positively associated with the hospitalization but were not statistically significant (OR>1.00, p>0.05). Conclusions: There is an increasing trend of leukemia related ED utilization and associated total and mean/median costs over time, while the rate of hospitalization for leukemia associated visit from ED have decreased. Oncology providers need to plan care accordingly to reduce ER visits and hospital admission for patients with leukemia. Disclosures No relevant conflicts of interest to declare.

Introduction: Multiple myeloma is comparatively uncommon cancer, but among blood malignancies it is still the second most common cancer after non-Hodgkin lymphoma. Patients with complications of multiple myeloma (MM) frequently present to the emergency department. There is a lack of data about the health care burden and trends of utilization of emergency department services by MM patients. The objective of this study is to investigate the recent trends in resource utilization in the emergency departments for MM. Furthermore, we aimed to look for the demographic characteristics associated with the subsequent hospitalization of MM patients. We hypothesized that there has been an increase in the utilization of emergency department services for the management of MM patients in recent years. We further hypothesized that subsequent hospitalization rate may be decreasing with the availability of more efficacious and potentially less toxic drugs. Methods: For this study we obtained the data from United States National Emergency Department Sample (NEDS) years 2010-2014. For categorical variables, frequencies and proportions were generated and statistical significance was tested using a chi-squared test. Rate of myeloma associated emergency department visits were estimated by using US census population. Patients and hospital characteristics were entered in univariate analysis to predict in-patient admissions from the ED. Multivariable logistic regression was used to predict in-patient admissions for the variables that were found statistically significant in univariate analysis. All tests were two-sided with the statistical significance set at p < 0.05. All analyses were conducted using STATA 14.2v and no missing data was imputed. Results: Between 2010 to 2014, approximately 443,214 patients visited emergency departments (ED) with the diagnosis of MM, that accounted for 0.06 % of all emergency department visits. There was an absolute increase of 22% in MM related visits from 80,466 in 2010 to 98,279 in 2014. While the rate of emergency department service utilization by myeloma patient increased significantly by 19% (p=0.04). Overall 73% of myeloma related visits resulted in hospitalization, but over the study period trend of hospitalization decreased. The percentage of patients treated and discharged to home increased from 23% to 29% between 2010 to 2014. Total charges associated with myeloma related visits increased significantly from $315 million to $626 million during 2010 to 2014, with an annual increase in the rate (19.26%: p Conclusion: Multiple myeloma related emergency department service utilization and total charges are increasing over the observed time limit. While the incidence of hospitalization from emergency department is decreasing overtime. These findings can be explained on the basis of few facts. MM patients are living longer with the availability of newer drugs but remain uncured. Most patients will face relapse after the initial disease control, at which point they may need to utilize ED services more frequently. As better oral or intravenous drugs are available through oncology out-patient offices, limited MM drug choices are available in the hospital, majority of MM patients are discharged sooner from the hospitals resulting in reduced hospital admission rates as well as shorter hospital stay. Disclosures No relevant conflicts of interest to declare.