The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
17
04
2019
accepted:
06
08
2019
entrez:
29
8
2019
pubmed:
29
8
2019
medline:
7
3
2020
Statut:
epublish
Résumé
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). 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31461487
doi: 10.1371/journal.pone.0221406
pii: PONE-D-19-11034
pmc: PMC6713440
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0221406Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Br J Surg. 2001 Oct;88(10):1346-51
pubmed: 11578290
Ann Thorac Cardiovasc Surg. 2004 Apr;10(2):71-5
pubmed: 15209546
Health Care Manag Sci. 2006 Aug;9(3):269-79
pubmed: 17016933
Health Econ Rev. 2012 Aug 30;2(1):15
pubmed: 22935314
Endoscopy. 2013 Jun;45(6):433-8
pubmed: 23733727
Eur J Public Health. 2014 Dec;24(6):1023-8
pubmed: 24627542
Z Gastroenterol. 2015 Mar;53(3):183-98
pubmed: 25775168
J Gastrointest Surg. 2015 Jul;19(7):1229-35
pubmed: 25967140
Visc Med. 2016 Feb;32(1):29-35
pubmed: 27588293
Eur J Surg Oncol. 2017 Apr;43(4):696-702
pubmed: 28012715
Zhonghua Liu Xing Bing Xue Za Zhi. 2017 Jan 10;38(1):102-109
pubmed: 28100387
Z Gastroenterol. 2017 Oct;55(10):1038-1051
pubmed: 28902372
Chirurg. 2018 Mar;89(3):229-236
pubmed: 29417163
Int J Surg. 2018 Jun;54(Pt A):113-123
pubmed: 29723676
J Gastrointest Surg. 2019 Jan;23(1):67-75
pubmed: 30374816