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Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6741-6751. [PMID: 37306776 PMCID: PMC10258736 DOI: 10.1007/s00402-023-04929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. METHODS The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. RESULTS Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). CONCLUSION Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Orthopaedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Katharina Bredow
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Diel R, Nienhaus A. Cost-Benefit of Real-Time Multiplex PCR Testing of SARS-CoV-2 in German Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3447. [PMID: 36834141 PMCID: PMC9960777 DOI: 10.3390/ijerph20043447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The current Omicron COVID-19 pandemic has significant morbidity worldwide. OBJECTIVE Assess the cost-benefit relation of implementing PCR point-of-care (POCT) COVID-19 testing in the emergency rooms (ERs) of German hospitals and in the case of inpatient admission due to other acute illnesses. METHODS A deterministic decision-analytic model simulated the incremental costs of using the Savanna® Multiplex RT-PCR test compared to using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ERs prior to hospitalization or just prior to discharge. Direct and indirect costs were evaluated from the hospital perspective. Nasal or nasopharyngeal swabs of patients suspected to have COVID-19 by clinical judgement, but without POCT, were sent to external labs for RT-PCR testing. RESULTS In probabilistic sensitivity analysis, assuming a COVID-19 prevalence ranging between 15.6-41.2% and a hospitalization rate between 4.3-64.3%, implementing the Savanna® test saved, on average, €107 as compared to applying the clinical-judgement-only strategy. A revenue loss of €735 can be avoided when SARS-CoV-2 infection in patients coming unplanned to the hospital due to other acute illnesses are excluded immediately by POCT. CONCLUSIONS Using highly sensitive and specific PCR-POCT in patients suspected of COVID-19 infection at German ERs may significantly reduce hospital expenditures.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), 24015 Kiel, Germany
- Lung Clinic Grosshansdorf, Germany, Airway Disease Center North (ARCN), German Center for Lung Research (DZL), 22949 Großhansdorf, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Asadi F, Sabahi A, Ramezanghorbani N, Emami H. Challenges of implementing diagnostic-related groups and healthcare promotion in Iran: A strategic applied research. Health Sci Rep 2023; 6:e1115. [PMID: 36817628 PMCID: PMC9926889 DOI: 10.1002/hsr2.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Background and Aim Implementing the diagnostic-related groups (DRGs) promotes the efficiency of healthcare. Therefore, the present study aimed to identify the challenges facing implementing the DRGs in Iran. Methods The present study is a strategic applied research conducted in two phases. In the first phase, the challenges facing DRGs were extracted through a literature review. Then the collected data is entered into a checklist consisting of five sections including technological, cultural, organizational, strategic, and natural challenges. In the second phase, data were collected by purposive sampling and semistructured interviews with 10 managers of the Medical Services Organization of Tehran, Iran. Data analysis was performed by conventional content analysis using MAXQDA software and descriptive using SPSS software version 19. Results The challenges facing the implementing DGRs from the experts' perspective included technological, organizational, nature, strategic, and cultural in order of priority. The three main fundamental challenges were reported; lack of integrating the DGRs with health information system (70%), frequent changes of management (70%), reducing the quality of care following early patient discharge (60%). Conclusion The results of the present study showed that the DRG system faced with challenges and healthcare officials should apply policies and guidelines to reform the system before changing the reimbursement system in Iran. By considering the leading countries experiences in the nationalizing the DRG system field, the problems and solutions of the system can be identified and aid in the more successful implementation of these systems.
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Affiliation(s)
- Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical SciencesBirjand University of Medical SciencesBirjandIran
| | - Nahid Ramezanghorbani
- Department of Development & Coordination Scientific Information and Publications, Deputy of Research & TechnologyMinistry of Health & Medical EducationTehranIran
| | - Hassan Emami
- Department of Health Information Technology and Management, School of Allied Medical SciencesShahid Beheshti University of Medical SciencesTehranIran
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Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Lange C, Maurer FP, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Salzer HJ, Schoch O, Schönfeld N, Stahlmann R, Bauer T. Tuberkulose im Erwachsenenalter. Pneumologie 2022; 76:727-819. [DOI: 10.1055/a-1934-8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.
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Affiliation(s)
- Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - Folke Brinkmann
- Abteilung für pädiatrische Pneumologie/CF-Zentrum, Universitätskinderklinik der Ruhr-Universität Bochum, Bochum
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin
| | | | - Pia Hartmann
- Labor Dr. Wisplinghoff Köln, Klinische Infektiologie, Köln
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck
- Baylor College of Medicine and Texas Childrenʼs Hospital, Global TB Program, Houston, TX, USA
| | - Florian P. Maurer
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | | | | | | | - Ralf Stahlmann
- Institut für klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin, Berlin
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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Analyzing Hospital High Length of Stay Outliers in Turkey. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1159299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: The aim of this study is to examine length of stay (LOS) outliers by analyzing hospital administrative database.
Material and Methods: The Turkish Ministry of Health DRG grouper database was utilized to obtain hospital administrative data on discharges for 15 training and research hospitals in 2012. For each diagnosis-related group (DRG), the geometric mean plus two standard deviations were calculated to identify outliers. Analyses were conducted using descriptive statistics and logistic regression using generalized estimating equations (GEE).
Results: High LOS outliers found to be 4.4 % of the cases, they were responsible for 24.50 percent of all discharge days. Alcohol, drug use disorders, burns, and diseases of the ear, nose, mouth, and throat were the factors that had the greatest impact on high LOS outliers, according to the multivariate model.
Conclusion: A quarter of all inpatient days are made up of LOS outliers. Burns, neonate cases, and alcohol/drug use issues should all be carefully evaluated. In order to improve clinical quality and effectively manage hospital resources, hospital administrators and health policy makers should take length of stay outliers into consideration.
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Hodiamont F, Schatz C, Gesell D, Leidl R, Boulesteix AL, Nauck F, Wikert J, Jansky M, Kranz S, Bausewein C. COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use - a protocol for a cross-sectional multi-centre study. BMC Palliat Care 2022; 21:18. [PMID: 35120502 PMCID: PMC8814797 DOI: 10.1186/s12904-021-00897-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. Methods COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. Discussion This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. Trial registration German Register for Clinical Studies trial registration number: DRKS00020517.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Anne-Laure Boulesteix
- Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Steven Kranz
- German Association for Palliative Medicine, Berlin, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
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Simões Corrêa Galendi J, Yeo SY, Simic D, Grüll H, Stock S, Müller D. A time-driven activity-based costing approach of magnetic resonance-guided high-intensity focused ultrasound for cancer-induced bone pain. Int J Hyperthermia 2022; 39:173-180. [PMID: 35021942 DOI: 10.1080/02656736.2021.2023768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine resource consumption and total costs for providing magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) treatment to a patient with cancer-induced bone pain (CIBP). METHODS We conducted a time-driven activity-based costing (TD-ABC) of MR-HIFU treatments for CIBP from a hospital perspective. A European care-pathway (including a macro-, meso-, and micro-level) was designed to incorporate the care-delivery value chain. Time estimates were obtained from medical records and from prospective direct observations. To calculate the capacity cost rate, data from the controlling department of a German university hospital were allocated to the modules of the care pathway. Best- and worst-case scenarios were calculated by applying lower and upper bounds of time measurements. RESULTS The macro-level care pathway consisted of eight modules (i.e., outpatient consultations, pretreatment imaging, preparation, optimization, sonication, post-treatment, recovery, and anesthesia). The total cost of an MR-HIFU treatment amounted to €5147 per patient. Best- and worst-case scenarios yielded a total cost of €4092 and to €5876. According to cost categories, costs due to equipment accounted for 41% of total costs, followed by costs with personnel (32%), overhead (16%) and materials (11%). CONCLUSION MR-HIFU is an emerging noninvasive treatment for alleviating CIBP, with increasing evidence on treatment efficacy. This costing study can support MR-HIFU reimbursement negotiations and facilitate the adoption of MR-HIFU as first-line treatment for CIBP. The present TD-ABC model creates the opportunity of benchmarking the provision of MR-HIFU to bone tumor.Key pointsMagnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is an emerging noninvasive treatment modality for alleviating cancer-induced bone pain (CIBP).From a hospital perspective, the total cost of MR-HIFU amounted to €5147 per treatment.This time-driven activity-based costing model creates the opportunity of benchmarking the provision of MR-HIFU to bone tumor.
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sin Yuin Yeo
- Faculty of Medicine and University Hospital of Cologne, Institute of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - Dusan Simic
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Holger Grüll
- Faculty of Medicine and University Hospital of Cologne, Institute of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany.,Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Dirk Müller
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Schatz C, Leidl R, Plötz W, Bredow K, Buschner P. Preoperative patients' health decrease moderately, while hospital costs increase for hip and knee replacement due to the first COVID-19 lockdown in Germany. Knee Surg Sports Traumatol Arthrosc 2022; 30:3304-3310. [PMID: 35211774 PMCID: PMC8868037 DOI: 10.1007/s00167-022-06904-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was a comparison between osteoarthritis patients with primary hip and knee replacements before, during and after the first COVID-19 lockdown in Germany. Patients' preoperative health status is assumed to decrease, owing to delayed surgeries. Costs for patients with osteoarthritis were assumed to increase, for example, due to higher prices for protective equipment. Hence, a comparison of patients treated before, during and after the first lockdown is conducted. METHODS In total, 852 patients with primary hip or knee replacement were included from one hospital in Germany. Preoperative health status was measured with the WOMAC Score and the EQ-5D-5L. Hospital unit costs were calculated using a standardised cost calculation. Kruskal-Wallis tests and Chi-squared tests were applied for the statistical analyses. RESULTS The mean of the preoperative WOMAC Score was slightly higher (p < 0.01) for patients before the first lockdown, compared with patients afterwards. Means of the EQ-5D-5L were not significantly different regarding the lockdown status (NS). Length of stay was significantly reduced by approximately 1 day (p < 0.001). Total inpatient hospital unit costs per patient and per day were significantly higher for patients during and after the first lockdown (p < 0.001). CONCLUSION Preoperative health, measured with the WOMAC Score, worsened slightly for patients after the first lockdown compared with patients undergoing surgery before COVID-19. Preoperative health, measured using the EQ-5D-5L, was unaffected. Inpatient hospital unit costs increased significantly with the COVID-19 pandemic. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- LMU Munich School of Management, Institute of Health Economics and Health Care Management, Ludwig-Maximilians-Universität München, Munich, Germany. .,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany.
| | - Reiner Leidl
- LMU Munich School of Management, Institute of Health Economics and Health Care Management, Ludwig-Maximilians-Universität München, Munich, Germany ,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany ,Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Katharina Bredow
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Diel R, Nienhaus A. Point-of-care COVID-19 antigen testing in German emergency rooms - a cost-benefit analysis. Pulmonology 2021; 28:164-172. [PMID: 34315687 PMCID: PMC8257421 DOI: 10.1016/j.pulmoe.2021.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background The current COVID-19 pandemic is causing significant morbidity and death worldwide and produces significant socio-economic losses. Objective To assess the cost–benefit relation of implementing point-of-care COVID-19 antigen testing (POCT) in emergency rooms (ER) of German hospitals. Methods A deterministic decision-analytic model simulated the incremental costs of using the Sofia® SARS Antigen FIA test compared to those of using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ER, prior to hospitalization. Direct and indirect costs, with and without subsequent RT-PCR confirmation, were evaluated from the hospital perspective. Results With respect to ER patients, in base-case analysis, considering a COVID-19 prevalence of 15.6% and a hospitalization rate among COVID-19 suspects of 10.1%, POCT testing reduces average costs of hospitalized patients by €213 per tested patient if nasopharyngeal swabs of patients suspected to have COVID-19 are also sent to external labs for RT-PCR testing. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Sofia® SARS Antigen FIA saves on average about €210 as compared to applying the clinical-judgement-only strategy. The major part of cost savings, €159 or 75.9%, is due to the POC test´s high specificity resulting in a 21-fold lower proportion of unnecessary bed blocking at the first day of hospitalization. Conclusions Using highly specific rapid COVID-19 tests in COVID-19 suspects at German ER, despite of their sub-optimal sensitivity, may significantly reduce hospital expenditure.
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Affiliation(s)
- R Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), Kiel 24015, Germany; Lung Clinic Grosshansdorf, Germany. Airway Disease Center North (ARCN), German Center for Lung Research (DZL), Großhansdorf, 22949, Germany; Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg 22089, Germany.
| | - A Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg 22089, Germany; Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
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Describing Serbian Hospital Activity Using Australian Refined Diagnosis Related Groups: A Case Study in Vojvodina Province. Zdr Varst 2020; 59:18-26. [PMID: 32952699 PMCID: PMC7478085 DOI: 10.2478/sjph-2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/16/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system. Methods L3H3, IQR, and 10th-95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV). Results There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. "Medical groups" accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. "Day-cases" and "prolonged hospitalisation" accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th-95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets. Conclusion A long length of stay and a small percentage of "day-cases" characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.
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Kabbani AR, Schultalbers M, Tergast T, Kimmann M, Stahmeyer J, Manns MP, Cornberg M, Maasoumy B, Becker H. [Influence of a spontaneous bacterial peritonitis, nosocomial infections and acute-on-chronic liver failure on treatment revenues in patients with decompensated cirrhosis in Germany]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:855-867. [PMID: 32947631 DOI: 10.1055/a-1217-7549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€ 10,653 vs. € 5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€ 473 vs. € 488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€ 10,307 vs. € 6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€ 443 vs. € 499, p = 0.18). ACLF increased treatment revenues to € 10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€ 483 vs. € 480, p = 0.29). CONCLUSION SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.
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Affiliation(s)
- Abdul-Rahman Kabbani
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany
| | - Marie Schultalbers
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany
| | - Tammo Tergast
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany
| | - Markus Kimmann
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany
| | - Jona Stahmeyer
- Institut für Epidemiologie Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Germany
| | - Michael P Manns
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany.,Deutsche Leberstiftung, Hannover, Germany.,Deutsches Zentrum für Infektionsforschung e.V., Standort Hannover-Braunschweig, Germany
| | - Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany.,Deutsche Leberstiftung, Hannover, Germany.,Deutsches Zentrum für Infektionsforschung e.V., Standort Hannover-Braunschweig, Germany
| | - Benjamin Maasoumy
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany.,Deutsche Leberstiftung, Hannover, Germany
| | - Hans Becker
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany.,Deutsche Leberstiftung, Hannover, Germany
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von der Warth R, Hehn P, Wolff J, Kaier K. Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study. HEALTH ECONOMICS REVIEW 2020; 10:23. [PMID: 32653959 PMCID: PMC7354685 DOI: 10.1186/s13561-020-00281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. METHODS The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. RESULTS N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268 - €3355], while reimbursement rose by €1387 [€563 - €2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. CONCLUSION Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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13
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Kaier K, Heister T, Wolff J, Wolkewitz M. Mechanical ventilation and the daily cost of ICU care. BMC Health Serv Res 2020; 20:267. [PMID: 32234048 PMCID: PMC7106643 DOI: 10.1186/s12913-020-05133-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 03/20/2020] [Indexed: 11/20/2022] Open
Abstract
Background Intensive care units represent one of the largest clinical cost centers in hospitals. Mechanical ventilation accounts for a significant share of this cost. There is a relative dearth of information quantifying the impact of ventilation on daily ICU cost. We thus determine daily costs of ICU care, incremental cost of mechanical ventilation per ICU day, and further differentiate cost by underlying diseases. Methods Total ICU costs, length of ICU stay, and duration of mechanical ventilation of all 10,637 adult patients treated in ICUs at a German hospital in 2013 were analyzed for never-ventilated patients (N = 9181), patients ventilated at least 1 day, (N = 1455) and all patients (N = 10,637). Total ICU costs were regressed on the number of ICU days. Finally, costs were analyzed separately by ICD-10 chapter of main diagnosis. Results Daily non-ventilated costs were €999 (95%CI €924 - €1074), and ventilated costs were €1590 (95%CI €1524 - €1657), a 59% increase. Costs per non-ventilated ICU day differed substantially and were lowest for endocrine, nutritional or metabolic diseases (€844), and highest for musculoskeletal diseases (€1357). Costs per ventilated ICU day were lowest for diseases of the circulatory system (€1439) and highest for cancer patients (€1594). The relative cost increase due to ventilation was highest for diseases of the respiratory system (94%) and even non-systematic for patients with musculoskeletal diseases (13%, p = 0.634). Conclusions Results show substantial variability of ICU costs for different underlying diseases and underline mechanical ventilation as an important driver of ICU costs.
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Affiliation(s)
- Klaus Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany.
| | - Thomas Heister
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Jan Wolff
- Klinik für Psychiatrie und Psychotherapie Universitätsklinikum Freiburg Medizinische Fakultät Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.,Evangelische Stiftung Neuerkerode, Klostergang 66, 38104, Braunschweig, Germany
| | - Martin Wolkewitz
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
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14
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Kaier K, Wolkewitz M, Hehn P, Mutters NT, Heister T. The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:1-11. [PMID: 31165960 DOI: 10.1007/s10754-019-09267-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011-2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately - €4000). While controls on average also have a negative reimbursement-cost difference (approximately - €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (- 1500, p < 0.01). HAIs caused by vancomycin-resistant Enterococci have the most unfavorable reimbursement-cost difference (- €10,800), significantly higher (- €9100, p < 0.05) than controls. Among infection types, pneumonia is associated with highest losses (- €8400 and - €5700 compared with controls, p < 0.05), while cost-reimbursement relationship for Clostridium difficile-associated diarrhea is comparatively balanced (- €3200 and - €500 compared to controls, p = 0.198). From the hospital administration's perspective, it is not the additional costs of HAIs, but rather the cost-reimbursement relationship which guides decisions. Costs exceeding reimbursements for HAI may increase infection prevention and control efforts and can be used to show their cost-effectiveness from the hospital perspective.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Nico T Mutters
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Straße 115 b, 79106, Freiburg, Germany
| | - Thomas Heister
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
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15
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Kaier K, Heister T, Götting T, Wolkewitz M, Mutters NT. Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital. BMC Infect Dis 2019; 19:1028. [PMID: 31795953 PMCID: PMC6888947 DOI: 10.1186/s12879-019-4660-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease. Methods Two hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders. Results Pseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases. Conclusions Pseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Thomas Heister
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Tim Götting
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Nico T Mutters
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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16
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Baltin C, Kron F, Urbanski A, Zander T, Kron A, Berlth F, Kleinert R, Hallek M, Hoelscher AH, Chon SH. The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy. PLoS One 2019; 14:e0221406. [PMID: 31461487 PMCID: PMC6713440 DOI: 10.1371/journal.pone.0221406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Complications after surgery for esophageal cancer are associated with significant resource utilization. The aim of this study was to analyze the economic burden of two frequently used endoscopic treatments for anastomotic leak management after esophageal surgery: Treatment with a Self-expanding Metal Stent (SEMS) and Endoscopic Vacuum Therapy (EVT). Materials and methods Between January 2012 and December 2016, we identified 60 German-Diagnosis Related Group (G-DRG) cases of patients who received a SEMS and / or EVT for esophageal anastomotic leaks. Direct costs per case were analyzed according to the Institute for Remuneration System in Hospitals (InEK) cost-accounting approach by comparing DRG payments on the case level, including all extra fees per DRG catalogue. Results In total, 60 DRG cases were identified. Of these, 15 patients were excluded because they received a combination of SEMS and EVT. Another 6 cases could not be included due to incomplete DRG data. Finally, N = 39 DRG cases were analyzed from a profit-center perspective. A further analysis of the most frequent DRG code -G03- including InEK cost accounting, revealed almost twice the deficit for the EVT group (N = 13 cases, € - 9.282 per average case) compared to that for the SEMS group (N = 9 cases, € - 5.156 per average case). Conclusion Endoscopic treatments with SEMS and EVT for anastomotic leaks following oncological Ivor Lewis esophagectomies are not cost-efficient for German hospitals. Due to longer hospitalization and insufficient reimbursements, EVT is twice as costly as SEMS treatment. An adequate DRG cost compensation is needed for SEMS and EVT.
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Affiliation(s)
- Christoph Baltin
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Florian Kron
- FOM University of Applied Sciences, Essen, Germany
- Department of Internal Medicine Med I, University Hospital of Cologne, Cologne, Germany
| | - Alexander Urbanski
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Anna Kron
- FOM University of Applied Sciences, Essen, Germany
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Robert Kleinert
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine Med I, University Hospital of Cologne, Cologne, Germany
| | | | - Seung-Hun Chon
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
- * E-mail:
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17
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Cyganska M, Cyganski P, Pyke C. Development of clinical value unit method for calculating patient costs. HEALTH ECONOMICS 2019; 28:971-983. [PMID: 31155799 DOI: 10.1002/hec.3902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/04/2019] [Accepted: 05/11/2019] [Indexed: 06/09/2023]
Abstract
The objective of the study was to develop the clinical value unit method of allocating indirect costs to patient costs using clinical factors. The method was tested to determine whether it is a more reliable alternative to using the length of stay and marginal mark-up allocation method. The method developed used data from a Polish specialist hospital. The study involved 4,026 patients grouped into nine diagnosis-related groups (DRG). The study methodology involved a three stage approach: (a) identification of correlates of patient costs, (b) a comparison of the costs calculated using the clinical value unit method with the alternative methods: length of stay and marginal mark-up methods, and (c) an estimation of the cost homogeneity of the DRGs. The study showed that length of stay cost allocation method may underestimate the proportion of indirect costs in patient costs for a short in-patient stay and overestimate the cost for the patients with a long stay. The total costs estimated using the marginal mark-up method were higher than those estimated with length of stay method. For most surgical procedures, the mean indirect costs are higher using clinical value unit method than when using length of stay or marginal mark-up method. In all medical procedure cases, the mean indirect costs calculated using the clinical value unit method are in the range between marginal mark-up and length of stay method. We also show that in all DRGs except one, that the coefficient of homogeneity for clinical value unit is higher than for length of stay or marginal mark-up method. We conclude that the clinical value unit method of cost allocation is a more precise and reliable alternative than the other methods.
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Affiliation(s)
- Malgorzata Cyganska
- Faculty of Economics, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Piotr Cyganski
- Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Chris Pyke
- Lancashire School of Business and Enterprise, University of Central Lancashire, Preston, UK
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Stollhof LE, Braun JM, Ihle C, Schreiner AJ, Kufeldt J, Adolph M, Wintermeyer E, Stöckle U, Nüssler A. The continuous downgrading of malnutrition in the German DRG system: possible effects on the treatment of patients at risk for malnutrition. EXCLI JOURNAL 2019; 18:370-381. [PMID: 31338008 PMCID: PMC6635725 DOI: 10.17179/excli2019-1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
It has been internationally recognized that malnutrition is an independent risk factor for patients' clinical outcome. A new mandatory fixed price payment system based on diagnosis-related groups (G-DRG) went into effect in 2004. The aim of our study was to demonstrate the importance of carefully coding the secondary diagnosis of "malnutrition" in the G-DRG system and to highlight how the economic relevance of malnutrition in the G-DRG system has changed from 2014 to 2016. 1372 inpatients at the Berufsgenossenschaftliche Unfallklinik (Trauma Center) in Tübingen were screened for the risk of malnutrition using Nutritional Risk Screening (NRS-2002). Patient data were compared with the NRS values collected during the study and a case simulation was carried out separately for each year. We used the codes E44.0 for NRS = 3 and E43.0 for NRS > 3. The ICD codes were entered as an additional secondary diagnosis in the internal hospital accounting system DIACOS to determine possible changes in the effective weight. In 2014 the highest additional revenue by far was calculated by coding malnutrition. For the 638 patients enrolled in the study in 2014, we were able to calculate an average additional revenue per patient coded with malnourishment of €107. In 2016, we were unable to calculate any additional revenue for the 149 patients enrolled. Although it is well known that malnutrition is an independent risk factor for poor patient outcomes, nationwide screening for a risk of malnutrition when patients are admitted to a hospital is still not required. For this reason, malnutrition in German hospitals continues to be insufficiently documented. Due to the continuous downgrading of diagnosis-related severity (CCL) of malnutrition in the G-DRG system in trauma surgery patients, it is no longer possible to refinance the costs incurred by malnourished patients through the conscientious coding of malnutrition. We assume that the indirect positive effects of nutritional interventions will have to be taken into account more in the costing calculations and possibly lead to indirect cost compensation.
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Affiliation(s)
- Laura E Stollhof
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Jessica M Braun
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Christoph Ihle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Anna J Schreiner
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Johannes Kufeldt
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Michael Adolph
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Elke Wintermeyer
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Ulrich Stöckle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Andreas Nüssler
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
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Diel R, Nienhaus A. Cost-Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132368. [PMID: 31277347 PMCID: PMC6651271 DOI: 10.3390/ijerph16132368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022]
Abstract
Background: Seasonal influenza causes significant morbidity worldwide and has a substantial economic impact on the healthcare system. Objective: To assess the cost–benefit relation of implementing a real-time influenza test in emergency rooms (ER) of German hospitals. Methods: A deterministic decision-analytic model was developed simulating the incremental costs of using the Solana® Influenza A+B test, compared to those of using conventional clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients, in German ER, prior to hospitalization. Direct costs were evaluated from the hospital perspective, considering resource use directly related to influenza testing and treatment, as well as indirect costs incurred by nosocomial influenza transmission. Results: Through base-case analysis and assuming an influenza prevalence of 42.6%, real-time testing with Solana® reduced average costs of hospitalized ILI patients by €132.61, per tested patient. Moreover, the Solana® saved €6.9 per tested patient in favor of the hospital. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Solana® saved on average €144.13 as compared to applying the clinical-judgement-only strategy, thus, it was found to be constantly less expensive. Conclusions: Using highly sensitive and specific real-time influenza tests in ILI patients at German ER might significantly reduce hospital expenditures
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), 24015 Kiel, Germany.
- Lung Clinic Grosshansdorf, Germany. Airway Disease Center North (ARCN), German Center for Lung Research (DZL), 22949 Großhansdorf, Germany.
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Schildmann E, Hodiamont F, Leidl R, Maier BO, Bausewein C. Which Reimbursement System Fits Inpatient Palliative Care? A Qualitative Interview Study on Clinicians' and Financing Experts' Experiences and Views. J Palliat Med 2019; 22:1378-1385. [PMID: 31210558 DOI: 10.1089/jpm.2019.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Internationally, a variety of reimbursement systems exists for palliative care (PC). In Germany, PC units (PCUs) may choose between per-diem rates and diagnosis-related groups (DRGs). Both systems are controversially discussed. Objectives: To explore the experiences and views of German PCU clinicians and experts for PCU financing regarding per-diem rates and DRGs as reimbursement systems with a focus on (1) cost coverage, (2) strengths and weaknesses of both financing systems, and (3) options for further development of funding PCUs. Design: Qualitative semistructured interviews with PCU clinicians and experts for PCU financing, analyzed by thematic analysis using the Framework approach. Setting/Subjects/Measurements: Ten clinicians and 13 experts for financing were interviewed June-October 2015 on both reimbursement systems for PCU. Results: Interviewees had divergent experiences with both reimbursement systems regarding cost coverage. A described strength of per-diem rates was the perceived possibility of individual care without direct financial pressure. The nationwide variation of per-diem rates and the lack of quality standards were named as weaknesses. DRGs were criticized for incentives perceived as perverse and inadequate representation of PC-specific procedures. However, the quality standards for PCUs required within the German DRG system were described as important strength. Suggestions for improvement of the funding system pointed toward a combination of per-diem rates with a grading according to disease severity/complexity of care. Conclusions: Expert opinions suggest that neither current DRGs nor per-diem rates are ideal for funding of PCUs. Suggested improvements regarding adequate funding of PCUs resemble and supplement international developments.
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Affiliation(s)
- Eva Schildmann
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Munich, Germany.,Munich School of Management, Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josef-Hospital, Wiesbaden, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
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Kaier K, von Zur Mühlen C, Zirlik A, Bothe W, Hehn P, Zehender M, Bode C, Stachon P. Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:625-632. [PMID: 30600467 DOI: 10.1007/s10198-018-1023-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease, with a dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Based on a retrospective cohort of isolated SAVR and TAVR procedures performed in Germany in 2015 (N = 17,826), we examine the impact of treatment selection on in-hospital mortality and total in-hospital costs for a variety of at-risk populations. Since patients were not randomized to the two treatment options, the two endpoints in-hospital mortality and reimbursement are analyzed using logistic and linear regression models with 20 predefined patient characteristics as potential confounders. Incremental cost-effectiveness ratios were calculated as a ratio of the risk-adjusted reimbursement and mortality differences with 95% confidence intervals obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly that SAVR and that cost differences between the procedures vary little between patient groups. Results regarding in-hospital mortality are mixed. SAVR is the predominant procedure among younger patients. For patients older than 85 years or at intermediate and higher pre-operative risk TF-TAVR seems to be the treatment of choice. Incremental cost-effectiveness ratios (ICER) are most favorable for patients older than 85 years (ICER €154,839, 95% CI €89,163-€302,862), followed by patients at higher pre-operative risk (ICER €413,745, 95% CI €258,027-€952,273). A hypothetical shift from SAVR towards TF-TAVR among patients at intermediate pre-operative risk is associated with a less favorable ICER (€1,486,118, 95% CI €764,732-€23,692,323), as the risk-adjusted mortality benefit is relatively small (- 0.97% point), while the additional reimbursement is still eminent (+€14,464). From a German healthcare system payer's perspective, the additional costs per life saved due to TAVR are most favorable for patients older than 85 and/or at higher pre-operative risk.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Bothe
- Department of Cardiac and Vascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany.
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Diel R, Nienhaus A. Rapid Point-of-Care Influenza Testing for Patients in German Emergency Rooms - A Cost-Benefit Analysis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2019; 6:203-212. [PMID: 32685592 PMCID: PMC7299473 DOI: 10.36469/001c.11206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/08/2019] [Accepted: 12/11/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND Each year, influenza causes significant morbidity and death worldwide and produces significant economic losses at the expense of the healthcare system. OBJECTIVE To assess the cost-benefit relationship of implementing a rapid point-of-care (POC) influenza test in emergency rooms (ERs) of German hospitals. METHODS A deterministic decision-analytic model simulated the incremental costs of using the Sofia® Influenza A+B test compared to those of using clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients in German ERs prior to hospitalization. Direct costs, with and without subsequent oseltamivir treatment, were evaluated from the hospital perspective as well as indirect costs incurred by nosocomial influenza transmission to hospital employees. RESULTS In base-case analysis, taking the influenza prevalence of 25.9% in the season 2018/2019 and assuming a hospitalization rate among influenza suspects of 21.9%, rapid testing with the Sofia® followed by administering oseltamivir to patients testing positive reduced average costs of hospitalized ILI patients by €52.16 per tested patient. If oseltamivir was not offered, testing with the Sofia® reduced costs by €42.28 in favor of the hospital.In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Sofia® saved on average €119.89 as compared to applying the clinical-judgement-only strategy. The major part of the cost savings, €113.17 or 94.4%, was due to the POC test's high specificity, which led to 91% reduction in needless bed-blocking on the first day of hospitalization. However, as the sensitivity of 75.3% was only slightly higher than that of conventional clinical judgement, improved classification of patients with true influenza and a correspondingly lower rate of illness in hospital employees could not be achieved. CONCLUSIONS Using highly specific rapid POC influenza tests in ILI patients at German ER, despite their sub-optimal sensitivity, may significantly reduce hospital expenditures.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), Kiel 24015,
Germany
- Lung Clinic Grosshansdorf, Germany. Airway Disease Center North (ARCN), German Center for Lung Research (DZL), Großhansdorf, 22949,
Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg 22089,
Germany
- Corresponding author: Tel.: +49-(0)-1724578525, E-mail address:
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg 22089,
Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, 20246,
Germany
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23
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Hulliger B, Sterchi M. A survey-based design of a pricing system for psychotherapy. HEALTH ECONOMICS REVIEW 2018; 8:29. [PMID: 30426305 PMCID: PMC6755576 DOI: 10.1186/s13561-018-0213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
For admission to statutory health insurance, it is common in Switzerland that health care providers negotiate prices for health care services directly with health insurers. Once they agree upon a price, they must submit the resulting price to the Federal Office of Public Health (FOPH), which can then authorize it. Swiss law requires the prices in health care to be based on empirical data. There has been little research on how to derive such a price for health care from empirical data and which data should be used. Based on a collaboration with psychological psychotherapists in Switzerland, we have designed a pricing system. The empirical basis were two representative surveys: a survey about costs and earnings of psychotherapists, as well as a time-use survey for psychotherapy. This paper shows the methodology followed to establish an empirically based pricing system. The paper may serve as a practical guide for health service providers who want to develop a pricing system. Our approach offers a high degree of freedom because it involves the collection of the data and an explicit modelling phase. At the same time, it might be more resource intensive than other approaches that are based on existing data sources.
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Affiliation(s)
- Beat Hulliger
- Institute for Competitiveness and Communication, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Riggenbachstrasse 16, 4600 Olten, Switzerland
| | - Martin Sterchi
- Institute for Competitiveness and Communication, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Riggenbachstrasse 16, 4600 Olten, Switzerland
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Convertino I, Salvadori S, Pecori A, Galiulo MT, Ferraro S, Parrilli M, Corona T, Turchetti G, Blandizzi C, Tuccori M. Potential Direct Costs of Adverse Drug Events and Possible Cost Savings Achievable by their Prevention in Tuscany, Italy: A Model-Based Analysis. Drug Saf 2018; 42:427-444. [PMID: 30276630 DOI: 10.1007/s40264-018-0737-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adverse drug events (ADEs) may represent an important item of expenditure for healthcare systems and their prevention could be associated with a relevant cost saving. OBJECTIVE The objective of this study was to simulate the annual economic burden for ADEs in Tuscany (Italy) and the potential cost savings related to avoidable ADEs. METHODS A systematic review was performed, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statements, on observational studies published from 2006 to 2016 in MEDLINE and EMBASE, focusing on direct costs of ADEs in the inpatient setting from high-income countries. The mean probability of preventable ADEs was estimated over the included studies. The mean ADE cost was calculated by means of Monte Carlo simulation. We then extrapolated the spontaneous reports of ADEs in Tuscany, Italy in 2016 from the Italian National Pharmacovigilance Network (Rete Nazionale di Farmacovigilanza), and we assumed the same costs and preventability probability for these as obtained in the systematic review. Finally, we simulated the possible costs of ADEs and preventable ADEs in Tuscany. Three sensitivity analyses were also performed to test the robustness of the results. RESULTS Of 11,936 articles initially selected, 12 observational studies were included. The estimated mean [± standard deviation (SD)] ADE cost was €2471.46 (± €1214.13). The mean (± SD) probability of preventable ADEs was 45% (± 21). The Tuscan expenditure for ADEs was €3,406,280.63 per million inhabitants (95% confidence interval (CI) 1,732,910.44-5,079,664.61) and the potential cost saving was €1,532,760.25 per million inhabitants (95% CI 779,776.1-2,285,750.60). Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS The present simulation showed that ADEs could have a relevant economic impact on the Tuscan healthcare system. In this setting, the prevention of ADEs would result in important cost savings. These results could be likely extended to other healthcare systems.
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Affiliation(s)
- Irma Convertino
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessandro Pecori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Maria Teresa Galiulo
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Parrilli
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Tiberio Corona
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Giuseppe Turchetti
- Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Corrado Blandizzi
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy
| | - Marco Tuccori
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. .,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy. .,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy.
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25
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Engler-Hüsch S, Heister T, Mutters NT, Wolff J, Kaier K. In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital. BMC Health Serv Res 2018; 18:737. [PMID: 30257671 PMCID: PMC6158851 DOI: 10.1186/s12913-018-3549-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/20/2018] [Indexed: 01/02/2023] Open
Abstract
Background Antibiotic resistance is a challenge in the management of infectious diseases and can cause substantial cost. Even without the onset of infection, measures must be taken, as patients colonized with multi-drug resistant (MDR) pathogens may transmit the pathogen. We aim to quantify the cost of community-acquired MDR colonizations using routine data from a German teaching hospital. Methods All 2006 cases of documented MDR colonization at hospital admission recorded from 2011 to 2014 are matched to 7917 unexposed controls with the same primary diagnosis. Cases with an onset MDR infection are excluded from the analysis. Routine data on costs per case is analysed for three groups of MDR bacteria: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and multidrug-resistant gram-negative bacteria (MDR-GN). Multivariate analyses are conducted to adjust for potential confounders. Results After controlling for main diagnosis group, age, sex, and Charlson Comorbidity Index, MDR colonization is associated with substantial additional costs from the healthcare perspective (€1480.9, 95%CI €1286.4–€1675.5). Heterogeneity between pathogens remains. Colonization with MDR-GN leads to the largest cost increase (€1966.0, 95%CI €1634.6–€2297.4), followed by MRSA with €1651.3 (95%CI €1279.1–€2023.6), and VRE with €879.2 (95%CI €604.1–€1154.2). At the same time, MDR-GN is associated with additional reimbursements of €887.8 (95%CI €722.1–€1053.6), i.e. costs associated with MDR-colonization exceed reimbursement. Conclusions Even without the onset of invasive infection, documented MDR-colonization at hospital admission is associated with increased hospital costs, which are not fully covered within the German DRG-based hospital payment system. Electronic supplementary material The online version of this article (10.1186/s12913-018-3549-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Engler-Hüsch
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Thomas Heister
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany.
| | - Nico T Mutters
- Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Wolff
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
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Präger M, Kiechle M, Stollenwerk B, Hinzen C, Glatz J, Vogl M, Leidl R. Costs and effects of intra-operative fluorescence molecular imaging - A model-based, early assessment. PLoS One 2018; 13:e0198137. [PMID: 29856875 PMCID: PMC5983425 DOI: 10.1371/journal.pone.0198137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/14/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Successful breast conserving cancer surgeries come along with tumor free resection margins and account for cosmetic outcome. Positive margins increase the likelihood of tumor recurrence. Intra-operative fluorescence molecular imaging (IFMI) aims to focus surgery on malignant tissue thus substantially lowering the presence of positive margins as compared with standard techniques of breast conservation (ST). A goal of this paper is to assess the incremental number of surgeries and costs of IFMI vs. ST. Methods We developed a decision analytical model and applied it for an early evaluation approach. Given uncertainty we considered that IFMI might reduce the proportion of positive margins found by ST from all to none and this proportion is assumed to be reduced to 10% for the base case. Inputs included data from the literature and a range of effect estimates. For the costs of IFMI, respective cost components were added to those of ST. Results The base case reduction lowered number of surgeries (mean [95% confidence interval]) by 0.22 [0.15; 0.30] and changed costs (mean [95% confidence interval]) by €-663 [€-1,584; €50]. A tornado diagram identified the Diagnosis Related Group (DRG) costs, the proportion of positive margins of ST, the staff time saving factor and the duration of frozen section analysis (FSA) as important determinants of this cost. Conclusions These early results indicate that IFMI may be more effective than ST and through the reduction of positive margins it is possible to save follow-up surgeries–indicating further health risk–and to save costs through this margin reduction and the avoidance of FSA.
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Affiliation(s)
- Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- * E-mail:
| | - Marion Kiechle
- Center for Hereditary Breast and Ovarian Cancer, Department of Gynecology, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
| | - Christoph Hinzen
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Chair for Biological Imaging, Technical University Munich, Munich, Germany
| | - Jürgen Glatz
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Chair for Biological Imaging, Technical University Munich, Munich, Germany
| | - Matthias Vogl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
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Vogl M, Schildmann E, Leidl R, Hodiamont F, Kalies H, Maier BO, Schlemmer M, Roller S, Bausewein C. Redefining diagnosis-related groups (DRGs) for palliative care - a cross-sectional study in two German centres. BMC Palliat Care 2018; 17:58. [PMID: 29622004 PMCID: PMC5887171 DOI: 10.1186/s12904-018-0307-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. METHODS Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. RESULTS Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. CONCLUSIONS Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not reproduce the costs adequately, but causes a financing gap for inpatient palliative care.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Eva Schildmann
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Farina Hodiamont
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Helen Kalies
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Marcus Schlemmer
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Susanne Roller
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Claudia Bausewein
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
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Kaier K, Reinecke H, Naci H, Frankenstein L, Bode M, Vach W, Hehn P, Zirlik A, Zehender M, Reinöhl J. The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:223-228. [PMID: 28229254 DOI: 10.1007/s10198-017-0877-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified. METHODS In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses. RESULTS A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment. CONCLUSIONS Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.
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Affiliation(s)
- Klaus Kaier
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Huseyin Naci
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Martin Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
- Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany
| | - Werner Vach
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Philip Hehn
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
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Wolff J, Heister T, Normann C, Kaier K. Hospital costs associated with psychiatric comorbidities: a retrospective study. BMC Health Serv Res 2018; 18:67. [PMID: 29382387 PMCID: PMC5791176 DOI: 10.1186/s12913-018-2892-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric comorbidities are relevant for the diagnostic and therapeutic regimes in somatic hospital care. The main aim of this study was to analyse the association between psychiatric comorbidities and hospital costs per inpatient episode. A further aim was to discuss and address the methodological challenges in the estimation of these outcomes based on retrospective data. METHODS The study included 338,162 inpatient episodes consecutively discharged between 2011 and 2014 at a German university hospital. We used detailed resource use data to calculate day-specific hospital costs. We adjusted analyses for sex, age, somatic comorbidities and main diagnoses. We addressed potential time-related bias in retrospective diagnosis data with sensitivity analyses. RESULTS Psychiatric comorbidities were associated with an increase in hospital costs per episode of 40% and an increase of reimbursement per episode of 28%, representing marginal effects of 1344 € and 1004 €, respectively. After controlling for length of stay, sensitivity analyses provided a lower bound increase in daily costs and reimbursement of 207 € and 151 €, respectively. CONCLUSION If differences in hospital costs between patient groups are not adequately accounted for in DRG-systems, perverse incentives are created that can reduce the efficiency of care. Therefore, we suggest intensifying the inclusion of psychiatric comorbidities in the German DRG system. Future research should investigate the appropriate inclusion of psychiatric comorbidities in other health care systems' payment schemes.
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Affiliation(s)
- Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Controlling, Evangelical Foundation Neuerkerode, Braunschweig, Germany
| | - Thomas Heister
- Institute for Medical Biometry and Statistics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Statistics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Walter J, Vogl M, Holderried M, Becker C, Brandes A, Sinner MF, Rogowski W, Maschmann J. Manual Compression versus Vascular Closing Device for Closing Access Puncture Site in Femoral Left-Heart Catheterization and Percutaneous Coronary Interventions: A Retrospective Cross-Sectional Comparison of Costs and Effects in Inpatient Care. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:769-776. [PMID: 28577694 DOI: 10.1016/j.jval.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 04/13/2016] [Accepted: 05/12/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare complication rates, length of hospital stay, and resulting costs between the use of manual compression and a vascular closing device (VCD) in both diagnostic and interventional catheterization in a German university hospital setting. METHODS A stratified analysis according to risk profiles was used to compare the risk of complications in a retrospective cross-sectional single-center study. Differences in costs and length of hospital stay were calculated using the recycled predictions method, based on regression coefficients from generalized linear models with gamma distribution. All models were adjusted for propensity score and possible confounders, such as age, sex, and comorbidities. The analysis was performed separately for diagnostic and interventional catheterization. RESULTS The unadjusted relative risk (RR) of complications was not significantly different in diagnostic catheterization when a VCD was used (RR = 0.70; 95% confidence interval [CI] 0.22-2.16) but significantly lower in interventional catheterization (RR = 0.44; 95% CI 0.21-0.93). Costs were on average €275 lower in the diagnostic group (95% CI -€478.0 to -€64.9; P = 0.006) and around €373 lower in the interventional group (95% CI -€630.0 to -€104.2; P = 0.014) when a VCD was used. The adjusted estimated average length of stay did not differ significantly between the use of a VCD and manual compression in both types of catheterization. CONCLUSIONS In interventional catheterization, VCDs significantly reduced unadjusted complication rates, as well as costs. A significant reduction in costs also supports their usage in diagnostic catheterization on a larger scale.
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Affiliation(s)
- Julia Walter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Matthias Vogl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Christian Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alina Brandes
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Munich, Germany
| | - Wolf Rogowski
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; University of Bremen, Health Sciences, Institute of Public Health and Nursing Research, Department of Health Care Management, Bremen, Germany
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Kron F, Kutsch N, Kostenko A, Dohle I, Glossmann JP, Müller D, Heimann SM, Bahlo J, von Bergwelt-Baildon M, Eichhorst B, Wolf J, Hallek M, Zander T. Economic evaluation of chronic lymphocytic leukemia from a hospital management perspective. Eur J Haematol 2016; 98:169-176. [PMID: 27727474 DOI: 10.1111/ejh.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Treatment of chronic lymphocytic leukemia (CLL) is currently undergoing dramatic changes. We analyzed economic risks in hospitalized patients with CLL from a management perspective. METHODS One hundred and twelve patients with CLL hospitalized in 2013 and 2014 at the University Hospital of Cologne were analyzed. To assess profit margins (PMs) per case, diagnosis-related group (DRG) reimbursement data were merged with an internal cost accounting scheme depending on age, prognostic factors, and DRG key performance indicators. RESULTS In 112 patients, 284 cases coded by 19 different DRG with strongly fluctuating cost revenue ratios were found with an overall negative PM of €137 147. The DRG R61H was identified as the one most commonly coded (174 cases, 61.3%) with a deficit per case of €814. Subanalysis demonstrated that the payments were not cost covering due to excessive length of stay and staff costs. Significant differences in PM per case concerning age, length of stay and number of operation and procedure key (OPS) codes (P < 0.05) were found. CONCLUSION In our research-driven tertiary care hospital, inpatient treatment of patients with CLL is not cost covering. This analysis demonstrates the need for novel care/reimbursement structures in CLL. From a hospital management perspective, cost revenue controlling is crucial to avoid major economic risks.
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Affiliation(s)
- Florian Kron
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Ines Dohle
- Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Jan-Peter Glossmann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.,Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Dirk Müller
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sebastian M Heimann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Thomas Zander
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
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Rimler SB, Gale BD, Reede DL. Diagnosis-related Groups and Hospital Inpatient Federal Reimbursement. Radiographics 2016; 35:1825-34. [PMID: 26466189 DOI: 10.1148/rg.2015150043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To understand the complex system of reimbursement for health care services, it is helpful to have a working knowledge of the historic context of diagnosis-related groups (DRGs), as well as their utility and increasing relevance. Congress implemented the DRG system in 1983 in response to rapidly increasing health care costs. The DRG system was designed to control hospital reimbursements by replacing retrospective payments with prospective payments for hospital charges. This article explains how these payments are calculated. Every inpatient admission is classified into one of several hundred DRGs that are based on the diagnosis, complications, and comorbidities. The Centers for Medicare & Medicaid Services (CMS) assigns each DRG a weight that the CMS uses in conjunction with hospital-specific data to determine reimbursement. A population's DRGs represent the resources needed to treat the medical disorders of that population. Hospital administrators use this information to budget and plan for the future. The Affordable Care Act and other recent legislation affect medical reimbursement by altering the DRG system. Radiologic procedures in particular are affected. This legislation will give DRGs an even larger role in determining reimbursements in the coming years.
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Affiliation(s)
- Simcha B Rimler
- From the Department of Radiology, SUNY Downstate Medical Center, Box 1278, 450 Clarkson Ave, Brooklyn, NY 11203
| | - Brian D Gale
- From the Department of Radiology, SUNY Downstate Medical Center, Box 1278, 450 Clarkson Ave, Brooklyn, NY 11203
| | - Deborah L Reede
- From the Department of Radiology, SUNY Downstate Medical Center, Box 1278, 450 Clarkson Ave, Brooklyn, NY 11203
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Malet-Larrea A, Goyenechea E, García-Cárdenas V, Calvo B, Arteche JM, Aranegui P, Zubeldia JJ, Gastelurrutia MA, Martínez-Martínez F, Benrimoj SI. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br J Clin Pharmacol 2016; 82:831-8. [PMID: 27195696 DOI: 10.1111/bcp.13012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/12/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs. METHODS This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months. Pharmacists in the comparison group (CG) delivered usual care. For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations. Inter-rater reliability was measured using Fleiss's kappa. Hospital costs were calculated using diagnosis related groups. RESULTS One thousand four hundred and three patients were included in the main study and they had 83 hospitalizations. Forty-two hospitalizations (50.6%) were medicine-related, with a substantial level of agreement among the experts (kappa = 0.65, 95% CI 0.52, 0.78, P < 0.01). The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0.042). The probability of being hospitalized was 3.7 times higher in the CG (odds ratio 3.7, 95% CI 1.2, 11.3, P = 0.021). Costs for a medicine-related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018]. CONCLUSION MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy.
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Affiliation(s)
- Amaia Malet-Larrea
- Pharmaceutical Technology Department, University of the Basque Country, Vitoria-Gasteiz
| | | | | | - Begoña Calvo
- Pharmaceutical Technology Department, University of the Basque Country, Vitoria-Gasteiz
| | - Jose M Arteche
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | - Pedro Aranegui
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | - Jose J Zubeldia
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | | | | | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Lung transplantation in the spotlight: Reasons for high-cost procedures. J Heart Lung Transplant 2016; 35:1227-1236. [PMID: 27377220 DOI: 10.1016/j.healun.2016.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/22/2016] [Accepted: 05/26/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hospital treatment costs of lung transplantation are insufficiently analyzed. Accordingly, it remains unknown, whether current Diagnosis Related Groups, merely accounting for 3 ventilation time intervals and length of hospital stay, reproduce costs properly, even when an increasing number of complex recipients are treated. Therefore, in this cost determination study, actual costs were calculated and cost drivers identified. METHODS A standardized microcosting approach allowed for individual cost calculations in 780 lung transplant patients taken care of at Hannover Medical School and University of Munich from 2009 to 2013. A generalized linear model facilitated the determination of characteristics predictive for inpatient costs. RESULTS Lung transplantation costs varied substantially by major diagnosis, with a mean of €85,946 (median €52,938 ± 3,081). Length of stay and ventilation time properly reproduced costs in many cases. However, complications requiring prolonged ventilation or reinterventions were identified as additional significant cost drivers, responsible for high costs. CONCLUSIONS Diagnosis Related Groups properly reproduce actual lung transplantation costs in straightforward cases, but costs in complex cases may remain underestimated. Improved grouping should consider major diagnosis, a higher gradation of ventilation time, and the number of reinterventions to allow for more reasonable reimbursement.
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Vogl M, Leidl R. Informing management on the future structure of hospital care: an extrapolation of trends in demand and costs in lung diseases. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:505-517. [PMID: 26032899 DOI: 10.1007/s10198-015-0699-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The planning of health care management benefits from understanding future trends in demand and costs. In the case of lung diseases in the national German hospital market, we therefore analyze the current structure of care, and forecast future trends in key process indicators. METHODS We use standardized, patient-level, activity-based costing from a national cost calculation data set of respiratory cases, representing 11.9-14.1 % of all cases in the major diagnostic category "respiratory system" from 2006 to 2012. To forecast hospital admissions, length of stay (LOS), and costs, the best adjusted models out of possible autoregressive integrated moving average models and exponential smoothing models are used. RESULTS The number of cases is predicted to increase substantially, from 1.1 million in 2006 to 1.5 million in 2018 (+2.7 % each year). LOS is expected to decrease from 7.9 to 6.1 days, and overall costs to increase from 2.7 to 4.5 billion euros (+4.3 % each year). Except for lung cancer (-2.3 % each year), costs for all respiratory disease areas increase: surgical interventions +9.2 % each year, COPD +3.9 %, bronchitis and asthma +1.7 %, infections +2.0 %, respiratory failure +2.6 %, and other diagnoses +8.5 % each year. The share of costs of surgical interventions in all costs of respiratory cases increases from 17.8 % in 2006 to 30.8 % in 2018. CONCLUSIONS Overall costs are expected to increase particularly because of an increasing share of expensive surgical interventions and rare diseases, and because of higher intensive care, operating room, and diagnostics and therapy costs.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Member of the German Center for Lung Research (DZL), Institute of Health Economics and Health Care Management (IGM), PO Box 1129, 85758, Neuherberg, Munich, Germany.
- Ludwig-Maximilians-Universität München, Munich School of Management, Institute of Health Economics and Health Care Management and Munich Centre of Health Sciences, Munich, Germany.
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Member of the German Center for Lung Research (DZL), Institute of Health Economics and Health Care Management (IGM), PO Box 1129, 85758, Neuherberg, Munich, Germany
- Ludwig-Maximilians-Universität München, Munich School of Management, Institute of Health Economics and Health Care Management and Munich Centre of Health Sciences, Munich, Germany
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Mihailovic N, Kocic S, Jakovljevic M. Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health Serv Res Manag Epidemiol 2016; 3:2333392816647892. [PMID: 28462278 PMCID: PMC5266471 DOI: 10.1177/2333392816647892] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.
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Affiliation(s)
| | - Sanja Kocic
- Institute for Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Diel R, Nienhaus A, Hillemann D, Richter E. Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals. Eur Respir J 2015; 47:575-87. [DOI: 10.1183/13993003.01333-2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/12/2015] [Indexed: 11/05/2022]
Abstract
Our objective was to assess the cost–benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.
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Zhang CY, Hashimoto H. How do patients and providers react to different incentives in the Chinese multiple health security systems? Chin Med J (Engl) 2015; 128:632-7. [PMID: 25698195 PMCID: PMC4834774 DOI: 10.4103/0366-6999.151661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes. Methods: The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives. Results: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider. Conclusions: Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.
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Affiliation(s)
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, China
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Jürges H, Köberlein J. What explains DRG upcoding in neonatology? The roles of financial incentives and infant health. JOURNAL OF HEALTH ECONOMICS 2015; 43:13-26. [PMID: 26114589 DOI: 10.1016/j.jhealeco.2015.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/22/2015] [Accepted: 06/02/2015] [Indexed: 06/04/2023]
Abstract
We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and German hospital data from 2006 to 2011, we show that (1) since the introduction of DRGs, hospitals have upcoded at least 12,000 preterm infants and gained additional reimbursement in excess of 100 million Euro; (2) upcoding rates are systematically higher at thresholds with larger reimbursement hikes and in hospitals that subsequently treat preterm infants, i.e. where the gains accrue; (3) upcoding is systematically linked with newborn health conditional on birth weight. Doctors and midwives respond to financial incentives by not upcoding newborns with low survival probabilities, and by upcoding infants with higher expected treatment costs.
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Affiliation(s)
- Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21 (FN), 42119 Wuppertal, Germany.
| | - Juliane Köberlein
- Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21 (FN), 42119 Wuppertal, Germany.
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Kawamoto K, Martin CJ, Williams K, Tu MC, Park CG, Hunter C, Staes CJ, Bray BE, Deshmukh VG, Holbrook RA, Morris SJ, Fedderson MB, Sletta A, Turnbull J, Mulvihill SJ, Crabtree GL, Entwistle DE, McKenna QL, Strong MB, Pendleton RC, Lee VS. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes. J Am Med Inform Assoc 2015; 22:223-35. [PMID: 25324556 PMCID: PMC4433359 DOI: 10.1136/amiajnl-2013-002511] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 08/08/2014] [Accepted: 08/22/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). MATERIALS AND METHODS In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. RESULTS A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. CONCLUSIONS The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Amy Sletta
- University of Utah, Salt Lake City, Utah, USA
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Mehra T, Hoetzenecker W, Moos R, Volbracht J, Guenova E, French LE, Hafner J. Inpatient Treatment for Severe Nonsurgical Dermatological Disorders: Prevalence, Care Infrastructure and Reimbursement in Switzerland. Dermatology 2015; 231:260-8. [DOI: 10.1159/000437223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/26/2015] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Since 2012, Swiss inpatient dermatology is funded through a flat rate payment system based on diagnosis-related groups (DRGs). <b><i>Objective:</i></b> To analyze the reimbursement of nonsurgically treated severe disorders of the skin under the system called SwissDRG. <b><i>Methods:</i></b> Three retrospective, cross-sectional cohort studies were performed. Data sets were received from the Swiss Federal Office of Statistics (1,285,685 retained records), the five Swiss university hospitals (370,964 retained records) and our center (72,211 retained records). <b><i>Results:</i></b> Cases accounted for 0.04% of all hospitalizations nationwide, with 43.7% treated at university hospitals. Treatment at university hospitals produced a mean loss of USD 3,711 per case. Lyell syndrome cases were especially underfunded (mean loss USD 31,906). Extra-county admissions and direct referrals were significant predictors of total inpatient costs (p = 0.019 and p < 0.001, respectively). <b><i>Conclusions:</i></b> We suggest grouping Lyell syndrome cases into burn DRGs and evaluating extra-county admissions and direct inpatient referrals as DRG split criteria.
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Vogl M, Wilkesmann R, Lausmann C, Plötz W. The impact of preoperative patient characteristics on the cost-effectiveness of total hip replacement: a cohort study. BMC Health Serv Res 2014; 14:342. [PMID: 25128014 PMCID: PMC4139612 DOI: 10.1186/1472-6963-14-342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022] Open
Abstract
Background To facilitate the discussion on the increasing number of total hip replacements (THR) and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research (CER) based on the preoperative health state. Methods In 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life (HRQoL) and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year (QALY) were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions. Results Mean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros. Conclusions The WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P,O, Box 1129, Neuherberg 85758, Germany.
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Vogl M. Hospital financing: calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme. Health Policy 2014; 115:141-51. [PMID: 24508182 DOI: 10.1016/j.healthpol.2014.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 01/09/2014] [Accepted: 01/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The paper analyzes the German inpatient capital costing scheme by assessing its cost module calculation. The costing scheme represents the first separated national calculation of performance-oriented capital cost lump sums per DRG. METHODS The three steps in the costing scheme are reviewed and assessed: (1) accrual of capital costs; (2) cost-center and cost category accounting; (3) data processing for capital cost modules. The assessment of each step is based on its level of transparency and efficiency. A comparative view on operating costing and the English costing scheme is given. RESULTS Advantages of the scheme are low participation hurdles, low calculation effort for G-DRG calculation participants, highly differentiated cost-center/cost category separation, and advanced patient-based resource allocation. The exclusion of relevant capital costs, nontransparent resource allocation, and unclear capital cost modules, limit the managerial relevance and transparency of the capital costing scheme. CONCLUSIONS The scheme generates the technical premises for a change from dual financing by insurances (operating costs) and state (capital costs) to a single financing source. The new capital costing scheme will intensify the discussion on how to solve the current investment backlog in Germany and can assist regulators in other countries with the introduction of accurate capital costing.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany; Ludwig-Maximilians-Universität München, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Munich, Germany.
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Reinöhl J, Gutmann A, Kollum M, von Zur Mühlen C, Baumbach H, Avlar M, Moser M, Bode C, Zehender M. Transfemoral aortic valve implantation: bleeding events, related costs and outcomes. J Thromb Thrombolysis 2013; 35:469-75. [PMID: 23108526 DOI: 10.1007/s11239-012-0829-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although less invasive then SAVR, TAVI is associated with a significant rate of access site and non-access site bleeding. These complications are major determinants of therapy outcome, however, the economic consequences are not well defined. The purpose of this study was to determine the relationship between bleeding, in-hospital resource utilization and costs among patients undergoing transfemoral aortic valve implantation (TF-AVI) at a representative university hospital in Germany. Between February 2010 and December 2011, we prospectively enrolled 60 consecutive patients undergoing TAVI using a 18F transfemoral approach at our institution. The relationship between overt bleeding (OVB), defined according to the definitions provided by the Valve Academic Research Consortium, in-hospital resource utilization and in-hospital costs was investigated. The mean age was 82 (±6) years, 53% were female and the mean EuroScore was 17.2% (±8, 7). Thirty-eight percent (23/60) of the patients had an OVB following TF-AVI procedure. In-hospital mortality was 8.7% in the OVB patients (2/23) and 2.7% among patients without any OVB (1/37; NOVB), which was not statistically significant (p = 0.3). The total length of stay (LOS) of patients with and without bleeding complication were 15.0 ± 6.4 and 10.4 ± 5.1 days, respectively (p < 0.01). Time spent on ICU in the OVB group was twice as long as compared to the NOVB group (120.5 ± 98.5 min vs. 63.6 ± 26.5 min, p < 0.01). Consequently, in-hospital costs were statistically significant higher in OVB patients (40.051 ± 9.293<euro> vs. 33.625 ± 4.368<euro>, p < 0.01). Bleeding is associated with increased resource use and in-hospital costs among TF-AVI patients. Our data indicates that strategies reducing bleeding risk may have the potential to generate important in-hospital costs reductions in TF-AVI patients.
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Affiliation(s)
- Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Seidel RP, Lux MP, Hoellthaler J, Beckmann MW, Voigt W. Economic constraints - the growing challenge for Western breast cancer centers. Breast Care (Basel) 2013; 8:41-7. [PMID: 24715842 PMCID: PMC3971806 DOI: 10.1159/000348356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Breast cancer care in Western countries has reached a considerable level of quality and standardization, which has contributed to the decline in breast cancer mortality. Certified Breast Cancer Centers (BCC) represent an important element of this development. Related to changes in reimbursement and growing costs, BCC face economic constraints which ultimately could endanger the achievements of the past. Thus, BCC have to optimize their care strategies from an economic perspective, particularly by increasing efficiency but also by adapting their service portfolio. This could result in competitive advantages and additional revenue by increasing case numbers and extra charges to patients. Furthermore, an intensification of collaboration with the outpatient sector resulting in an integrated and managed 'trans-sectoral' care approach which could allow to shift unprofitable procedures to the outpatient sector - in the sense of a win-win situation for both sectors and without loss of care quality - seems reasonable. Structured and specialized consulting approaches can further be a lever to fulfill economic requirements in order to avoid cuts in medical care quality for the sake of a balanced budget. In this review, economic constraints of BCC with a focus on the German healthcare system and potential approaches to ameliorate these financial burdens are being discussed.
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Affiliation(s)
- Rene P. Seidel
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Michael P. Lux
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Josef Hoellthaler
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Wieland Voigt
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
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Campbell E, Ross LF. Parental attitudes and beliefs regarding the genetic testing of children. Public Health Genomics 2005; 8:94-102. [PMID: 15925885 DOI: 10.1159/000084777] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To explore parental attitudes and beliefs about genetic testing of children for conditions that present throughout the life cycle. METHODS Twelve semi-structured focus groups with black and white parents were conducted. RESULTS Across racial groups, most respondents want access to genetic testing and believe that parents should be the final decision-makers. While most respondents believe it is important to share genetic information with relatives, white respondents want physicians to respect confidentiality absolutely, whereas some black respondents accept physician disclosures in specific situations. CONCLUSIONS Professional policy statements are restrictive about access to predictive genetic testing of children. This conflicts with parental attitudes about who should have decisional authority. While there is consensus among respondents that genetic information should be shared with relatives, respondents disagree as to who should be responsible for disclosure, and when professionals should breach patient confidentiality.
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