Analyse des coûts du traitement et de la rééducation des lésions nerveuses périphériques du membre supérieur en Allemagne

Abstract

Nerve injuries are considered to be highly cost intensive due to the necessary specialized therapy, rehabilitation and long healing process. So far no cost analyses are available of the German collective and even the German treatment guideline (AWMF – Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) refers to Swedish or Swiss data. This study evaluates for the first time the costs of peripheral nerve lesions within the German health system. All patients who suffered a work-related peripheral nerve lesion of the upper extremity and were treated in our hospital between 01, 2012 and 12, 2017 were analysed. For patients with a follow-up of 78 weeks within this period, the costs of inpatient treatment (diagnostics, operation, ward days) and rehabilitation were calculated. Out of 556 patients with work-related nerve injuries 250 had a completed follow up and could be calculated. The mean age of patients was 39.97 y. 153 patients had a single median nerve injury with mean acute care costs of 3569.94 €, 24 had a single radial nerve injury with mean costs of 3166.14 €, 57 patients had a single ulnar nerve injury revealing 2650.25 €, 18 had a combined median and ulnar nerve injury resulting in median costs of 11,402.47 € and 1 had a combined median and radial nerve injury with 2083.45 €. In 123 cases (49%) one or more tendons were also injured resulting mean costs of 5085.53 €, instead of 2660.16 € with no injured tendons. Mean hospital stay was 7.03 days. 16% required a rehabilitation with mean costs of 5842.35 € and a mean stay of 25.71 days. The mean of overall costs of inpatient stay and rehabilitation was 4788.22 €. Injury to the peripheral nerves of the upper extremity has a major impact on the function of the arm and hand, the patient's life and employment. The health care costs for inpatient treatment of these injuries are similar to those known from Sweden or Switzerland. Almost 50% had combined nerve and tendon injuries, which led to average increase of 61% in costs. A considerable high amount is needed for the rehabilitation part. The costs will be presented more detailed in the presentation due to limited space in the abstract.