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[Costs-proceeds calculation for radiotherapy; comment]
H J Thiel1, W A Oechsler, B Kastura
1Institut für Strahlentherapie, Klinikum Bamberg.
Summary
Modern radiotherapy is not cost-effective for 11 tumor entities, with significant underfunding evident, especially when including facility and investment costs. Reforms are urgently needed for accurate service payment and description in radiotherapy.
Area of Science:
- Oncology
- Health Economics
- Radiotherapy
Background:
- The Health Care Structure Bill and Federal Health Care Tariff Regulation introduced new challenges for hospital management, including internal budgeting.
- The study addresses the impending establishment of care-related lump sums (Fallpauschalen) and special allowances for radiation therapy (Sonderentgelte).
- A need was identified to assess the service-cost ratio for various tumor entities under new healthcare regulations.
Purpose of the Study:
- To determine the service-cost ratio for 11 tumor entities in outpatient radiotherapy.
- To compare calculated costs with actual proceeds from health insurance reimbursements.
- To evaluate the economic viability of modern radiotherapy under current German healthcare regulations.
Main Methods:
- Analysis included 11 tumor entities: Glioblastoma multiforme, head and neck squamous cell carcinoma, lung cancer, esophageal cancer, breast cancer, rectal and prostate cancer, anal canal and uterine cervix cancer, Hodgkin's disease, and bone metastases.
- Treatment costs were calculated based on process evaluation, dividing the complex treatment regime into distinct steps.
- Proceeds were calculated according to EBM (general health insurance) and GOA (private care insurance) regulations.
Main Results:
- Under EBM standards, only ENT tumors, anal canal cancer, and bone metastases showed a profit margin when excluding facility and investment costs. All others incurred losses.
- Including facility and investment costs, only bone metastases remained profitable; all other tumor entities resulted in significant financial losses.
- Under GOA standards, all tumor entities showed a loss, with median losses ranging from -44% to -56% when including facility and investment costs.
Conclusions:
- Modern standard radiotherapy is not cost-effective for the reviewed tumor entities, indicating considerable under-funding.
- The cost-proceeds ratio is particularly unsatisfactory under GOA calculations, which are deemed obsolete for current radiotherapy standards.
- Urgent reform of service description and payment is necessary to meet the standards of modern radiotherapy.