Effect of patient characteristics on hospital costs for cirrhosis: implications for the disease-related group (DRG) reimbursement system.

The Prospective Payment System uses Diagnosis-Related Groups (DRG) as a reimbursement system. DRG 202 is a disease-related group including liver cirrhosis as a whole. Patients referring to the inpatient unit complain of variable severity and complications of cirrhosis, possibly implying different expenditure of resources. Aim of the investigation was to identify factors affecting cost variability in patients with cirrhosis. A total of 73 consecutive, DRG 202-assigned, cirrhotic patients classified according to demographic and clinical variables were evaluated for length and costs of hospitalization calculated on a full-cost basis. Mean length of hospitalization was 10.2 +/- 7 days. Mean cost of hospitalization was Lit. 4.348.000 +/- 2.718.000. Medical, nursing, diagnostic, drug and general charges accounted for 13%, 29%, 37%, 5% and 16% of the cost, respectively. Child-Pugh score significantly correlated with drug consumption (p < 0.005), length (p < 0.01) and costs (p < 0.001) of hospitalization, but not with cost per day. Age, sex, admission status, referral reason, associated diseases and liver transplant susceptibility did not correlate with duration and costs of hospitalization. Disease severity significantly modifies costs of hospital admission in cirrhotic patients mostly on account of longer hospital stay. Surrogate indexes of disease severity, derived from ISTAT/DRG records, cannot identify patients consuming larger resources. In liver cirrhosis, the DRG system could be improved by introducing parameters, such as Child-Pugh score, directly taking into account disease severity.

Economic evaluation of diagnostic follow-up after primary treatment for breast cancer. Results of the Working Group on Economic-Organizational Aspects of Follow-up.

BACKGROUND: This study examined costs associated with different 5-year follow-up regimens (intensive vs. minimum) in patients after primary breast cancer treatment. METHODS: Since the results of two randomised controlled trials showed a similar 5-year survival for asymptomatic patients followed with frequent diagnostic tests and patients followed with only routine clinical controls, the economic savings resulting from the systematic adoption of a minimum surveillance regimen were estimated for Italy. RESULTS: When considering only direct health care costs (i.e., excluding time and travel costs) and adopting a minimalist policy, the average per patient savings (5% yearly compound rate) were calculated at 3.7 million Italian lire for paying patients, 2.5 million Italian lire for patient reimbursement from private voluntary/integrative health insurance funds, and to range from 1.2 to 2.1 million Italian lire for payment to the National Health Service (NHS). Total follow-up savings for the patient cohort which had breast surgery in the last 5 years were estimated to range from 29 to 51 billion Italian lire for the NHS, 92 billion Italian lire for paying patients and 62 billion Italian lire for the health insurance funds. CONCLUSIONS: Alternative use of these savings were discussed with reference to breast cancer screening programs.

[Cost-effectiveness analysis of extracorporeal lithotripsy]. / Analyse coûts-efficacité de la lithotripsie extra-corporelle.

The recent introduction of extracorporeal lithotripsy (ECL) for the treatment of urinary stones has raised new questions for doctors and economic policy decision makers. This study presents a cost-effectiveness analysis of extracorporeal lithotripsy conducted in an Italian hospital which has used a Sonolith 3000 lithotriptor since 1989. The overall cost of treatment by ECL (of a simple case of urinary stones) is 5,080 FF and the cost per cured case (taking into account the number of sessions per patient and the percentage of cured cases) varies between 6,200 FF and 9,500 FF. The results obtained (influenced by the lack of certain clinical data due to the recent use of this technique) appear to be in favour of extension of ECL treatments in comparison with surgical treatment due to their lower cost, lower morbidity and shorter convalescent period.

[Hospital costs of patients with AIDS]. / Costo ospedaliero del malato di AIDS.

We carried out a retrospective research into the hospital care cost of 52 AIDS cases we observed in our department, in the period 1984-1988. These patients required an average of 3.2 hospital admissions per year, and 101.3 hospitalization days per year, spending more than one fourth of their life span after their diagnosis of AIDS, in a hospital. The total care cost was Lit. 1,133,614,000, mostly due to the hospital stay (65.0%), but the introduction of expensive drugs will increase the cost of treatment. The average daily cost per patient was Lit. 227,900. Prognosis and cost vary according to the kind of opportunistic infection or neoplasm. The prolongation of hospitalization in consequence of social and economic problems is very frequent. A better accessibility of diagnostic systems, and a development of day-hospital and social services could reduce AIDS patients costs.