Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

Journal of Cardiothoracic Surgery

Terje P Hagen²  Ishtiaq Khushi³  Gro Sørensen⁴  Odd Geiran¹  Arnt E Fiane¹  Vinod Mishra² 

[1] Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Health Management and Health Economics, University of Oslo, Oslo, Norway;Health Services Research Center Akershus University Hospital, Oslo, Norway;Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway

关键词: Cost analysis;    DRG reimbursement;    Hospital cost;    Left ventricle assist device;    Innovative technology;   

Others  :  1153033
DOI  :  10.1186/1749-8090-7-76

 received in 2012-04-20, accepted in 2012-08-13,  发布年份 2012

【 摘 要 】

Background

The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3^rd generation Left Ventricle Assist Devices (LVAD). Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG)-reimbursement.

Method

Cost data of 20 LVAD implantations (VentrAssist™) from 2005-2009 (period 1) were analyzed together with costs from nine patients using another LVAD (HeartWare™) from 2009-June 2011 (period 2). For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices.

Results

The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299), and the corresponding DRG- reimbursement (2009) was $ 143, 192 . The mean LOS was 54 days (range 12- 127). For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664) and the corresponding DRG- reimbursement (2010) was $ 136, 963. The mean LOS was 49 days (range 31- 93).

The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14, 096 US$ (CI -3, 842 to -24, 349, p < 0.01).

Conclusion

There were significant reductions in total hospital costs per patient as the numbers of patients were increasing. This can possibly be explained by a learning effect including better logistics, selection and management of patients.

【 授权许可】

   
2012 Mishra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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