Abstract
Objective: For lung transplantation (LTX) effective costs and major cost drivers are poorly analyzed to date. Current DRGs account merely for length of stay and hours of artificial ventilation as cost drivers. The purpose of this study was to calculate actual LTX costs and evaluate the impact of major diagnoses, socio-demographic and clinical factors on cost development, a prerequisite for the refinement of prospective payment systems (DRGs).
Methods: We used a standardized micro-costing approach calculating costs individually for each of 255 LTX patients taken care of at Hannover Medical School and University of Munich, representing 50% of the German LTX-volume in 2009/10. A generalized linear model with gamma distribution and log link function was used to determine patient and care characteristics predictive for inpatient cost.
Results: Mean LTX costs were calculated at 75,875 Euros (median 48,682 Euros, SE 4,183 Euros). Compared to emphysema/COPD patients, costs were 50%, 38%, 43%, and 23% higher for cystic fibrosis, idiopathic pulmonary fibrosis, re-transplantation, and rare end-stage lung diseases, respectively. Costs increased significantly with additional side diagnoses like bleeding complications, postoperative respiratory failure, and by additional operation/procedure codes like repetitive transfusions or surgical re-interventions.
Conclusions: Current DRGs in Germany and other countries do not adequately differentiate LTX reimbursement and may set distorting economic incentives. Besides hours of artificial ventilation and length of stay, a more accurate DRG grouping for LTX should consider the number of side diagnoses, number of operation/procedure codes and major diagnoses to enable reasonable reimbursement.
- © 2014 ERS
