[Patient selection in tertiary hospitals based on economic data: exemplified by visceral surgery]. / Patientenauswahl in Krankenhäusern der Maximalversorgung auf Basis ökonomischer Daten: Beispiel Viszeralchirurgie.

BACKGROUND: With respect to economic aspects it remains questionable if tertiary hospitals should focus on operations with high complexity or if surgery for benign diseases should be performed as well. MATERIAL AND METHODS: Data from the Institute for Reimbursement in hospitals (InEK) were analyzed for esophageal and pancreatic surgery and for appendectomy, cholezystectomy and thyroid surgery. RESULTS: Operations with a high complexity showed a slightly better revenue-cost relation. Earnings in esophageal and pancreatic surgery varied between 590 EUR and 1,977 EUR, while in operations for benign diseases it ranged from 492 EUR to 1,648 EUR. In patients with a longer hospital stay this advantage diminished. The cost-revenue ratio was much more stable for patients with appendectomy, cholezystectomy or thyroid resection. CONCLUSIONS: For economic reasons tertiary hospitals need to treat not only oncology patients but also patients with benign diseases. The focus on surgery for malignant diseases is economically not recommended because the revenues may be drained by the costs particularly in patients with a longer hospital stay due to complications.

Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine.

OBJECTIVE: To investigate the long-term effects of continuous methimazole (MMI) therapy. DESIGN AND METHODS: Five hundred and four patients over 40 years of age with diffuse toxic goiter were treated with MMI for 18 months. Within one year after discontinuation of MMI, hyperthyroidism recurred in 104 patients. They were randomized into 2 groups for continuous antithyroid and radioiodine treatment. Numbers of occurrences of thyroid dysfunction and total costs of management were assessed during 10 years of follow-up. At the end of the study, 26 patients were still on continuous MMI (group 1), and of 41 radioiodine-treated patients (group 2), 16 were euthyroid and 25 became hypothyroid. Serum thyroid and lipid profiles, bone mineral density, and echocardiography data were obtained. RESULTS: There was no significant difference in age, sex, duration of symptoms and thyroid function between the two groups. No serious complications occurred in any of the patients. The cost of treatment was lower in group 1 than in group 2. At the end of 10 years, goiter rate was greater and antithyroperoxidase antibody concentration was higher in group 1 than in group 2. Serum cholesterol and low density lipoprotein-cholesterol concentrations were increased in group 2 as compared with group 1; relative risks were 1.8 (1.12-2.95, P<0.02) and 1.6 (1.09-2.34, P<0.02) respectively. Bone mineral density and echocardiographic measurements were not different between the two groups. CONCLUSION: Long-term continuous treatment of hyperthyroidism with MMI is safe. The complications and the expense of the treatment do not exceed those of radioactive iodine therapy.

[Cost minimization analysis for the definitive therapy of hyperthyroidism: comparison of goiter resection with radioiodine therapy]. / Kostenminimierungsstudie zur definitiven Therapie der Hyperthyreose: Vergleich zwischen Strumaresektion und Radiojodtherapie.

AIM: Cost-analysis of strumaresection and radioiodine treatment in patients with hyperthyreosis. METHOD: Matched by age, sex, comorbidity, volume of goiter, and entity of hyperthyreosis 18 patients of a clinic of surgery, and 28 patients of a clinic of nuclear medicine were analysed by the reimbursed costs, and by a retrospective calculation of the real costs. RESULTS: Based on the rate for the reimbursed costs the radioiodine treatment (6450 DM) was more favourably than the strumaresection (7562 DM); based on the calculation of the real costs including regional specialities there was a minimal difference in favour of the strumaresection (5185 DM versus 5562 DM) because of the selection of large goiters (median 53 ml), the longer hospitalisation after radioiodine treatment due to legal reasons (12.5 days), and the frequent controls before and after the radioiodine treatment. Most important cost-factor of the radioiodine treatment was the volume of goiter, most important cost-factor of the strumaresection was the age of the patient. The treatment of Graves disease was more expensive than that of autonomy in surgery as well as in nuclear medicine. CONCLUSION: In order to achieve cost-minimization, radioiodine treatment should be prefered in cases of small goiters or in older patients.