Related Experiment Videos
[Cost of diagnostic and therapeutic hemodynamic procedures: comparison with DRG reimbursement]
E Varani1, M Balducelli, G Vecchi
1Divisione di Cardiologia, Azienda USL, Ravenna. dicardra@auslra.village.telecomitalia.it
Insights
The costs for diagnostic and interventional catheterization procedures were found to be acceptable and aligned with reimbursement rates. Timely procedures offer economic savings and clinical benefits for patients.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- The cumulative costs of diagnostic and interventional procedures in catheterization laboratories within public hospitals remain largely unquantified.
- There is a growing emphasis on cost-effectiveness in healthcare, making such cost analyses crucial.
Purpose of the Study:
- To evaluate the costs associated with diagnostic and interventional procedures in a catheterization laboratory.
- To compare these costs with the reimbursements provided by Diagnosis-Related Groups (DRGs).
Main Methods:
- A cost evaluation was conducted from January to April 2000 in the catheterization laboratory of Ravenna USL.
- Costs included materials, medications, personnel, machinery, transportation, and general hospital expenditures.
- DRGs and reimbursements were calculated based on clinical indications and procedure modalities.
Main Results:
- A total of 268 patients underwent procedures, including coronary angiography and percutaneous coronary intervention (PCI).
- The cost of diagnostic catheterization was €632, while PCI (often with stent implantation) averaged €3044.
- DRG reimbursements varied, with PCI having a DRG of 112 valued at €10,235,000.
Conclusions:
- The costs of diagnostic and interventional hemodynamic procedures were deemed acceptable and proportional to DRG reimbursements.
- Appropriate and timely procedures during initial hospital stays result in economic savings for the healthcare system.
- These procedures offer clinical advantages for individual patients.
Background:
The cumulative costs of diagnostic and interventional procedures in the catheterization laboratory in public hospitals are still largely unknown, notwithstanding the present stress upon the cost-effectiveness issues in medicine.
Methods:
From January through April 2000 we have evaluated procedures in the catheterization laboratory of the Ravenna USL. Costs taken into consideration were the following: the mean cost of materials for each type of examination and of medications used for each patient, personnel costs, machinery mortgages' costs, ambulance transportation's costs, and general hospital expenditures. DRGs and reimbursements have been calculated on the basis of clinical indications and modalities of procedures.
Results:
During the evaluation period 268 patients have been studied. The procedures taken into consideration included: 135 coronary angiographies, 36 right and left catheterizations plus coronary angiography, 87 coronary angiographies plus percutaneous coronary intervention (PCI), 10 PCI. The total cost of diagnostic catheterization was Itl 1,226,000 (Euro 632) whereas that of each PCI (including stent implantation in 80% of cases) associated in 87 cases with coronary angiography was Itl 5,956,000 (Euro 3044). Patients with an acute coronary syndrome or heart failure were mostly studied during their first hospital stay; those with stable disease (stable angina, previous myocardial infarction, valvular heart disease or cardiomyopathy without heart failure) were studied during ordinary hospital admission or in the context of a day-hospital. DRGs and corresponding reimbursements for the different clinical situations were the following: unstable angina DRG 124 valued at Itl 6,180,000; stable angina DRG 125 valued at Itl 3,900,000; acute or recent myocardial infarction with or without complications DRG 121 or 122 valued at ItI 8,290,000 or Itl 5,900,000; heart failure in valvular heart disease or cardiomyopathy DRG 124 valued at Itl 6,180,000; valvular heart disease or cardiomyopathy DRG 125 valued at Itl 3,900,000. The DRG for a PCI is no. 112 valued at Itl 10,235,000.
Conclusions:
The costs of diagnostic and interventional hemodynamic procedures were acceptable and proportional to the DRG-related reimbursements. Appropriately indicated procedures and their quick execution during the first hospital stay lead to global economic savings for the health care system and are also clinically advantageous for the individual patient.