The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy

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 fo
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.
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Metadaten
Author:Christoph Baltin, Florian Kron, Alexander Urbanski, Thomas Zander, Anna Kron, Felix Berlth, Robert Kleinert, Michael Hallek, Arnulf H. Hölscher, Seung-Hun Chon
URN:urn:nbn:de:hebis:30:3-508506
DOI:http://dx.doi.org/10.1371/journal.pone.0221406
ISSN:1932-6203
Parent Title (English):PLoS one
Publisher:PLoS
Place of publication:Lawrence, Kan.
Contributor(s):Lars-Peter Kamolz
Document Type:Article
Language:English
Year of Completion:2019
Date of first Publication:2019/08/28
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2019/08/29
Tag:Cancer treatment; Digestive system procedures; Economics; Endoscopy; Esophagectomy; Health economics; Oncology; Surgical oncology
Volume:14
Issue:(8): e0221406
Pagenumber:12
First Page:1
Last Page:12
Note:
Copyright: © 2019 Baltin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
HeBIS PPN:453740944
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0

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