Lung transplantation in the spotlight: Reasons for high-cost procedures

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• 作者：Matthias Vogl ; PhD ; MBA^a ; ^b ; Gregor Warnecke ; MD ; PhD^c ; Axel Haverich ; MD ; PhD^c ; Jens Gottlieb ; MD ; PhD^d ; Tobias Welte ; MD ; PhD^d ; Rudolf Hatz ; MD ; PhD¹ ; ^e ; Matthias Hunger ; PhD^a ; Reiner Leidl ; PhD^a ; ^b ; Heidrun Lingner ; MD^f ; Juergen Behr ; MD ; PhD^g ; ¹ ; Hauke Winter ; MD ; PhD^e ; ¹ ; Rene Schramm ; MD ; PhD^h ; ¹ ; Bernhard Zwissler ; MD ; PhDⁱ ; ¹ ; Christian Hagl ; MD ; PhD^h ; ¹ ; Nicole Strobl ; MSc^e ; ¹ ; Cornelius Jaeger ; MSc^c ; Gerhard Preissler ; MD ; PhD^e ; ¹ ; ^{gerhard.preissler@med.uni-muenchen.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：lung transplantation ; DRG ; costs ; resource utilization ; economic evaluation
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：35
• 期：10
• 页码：1227-1236
• 全文大小：730 K

文摘

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.