Abstract
BackgroundComplications 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 methodsBetween 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.ResultsIn 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).ConclusionEndoscopic 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.
Highlights
In 2017, prognostic healthcare expenditures marked approximately € 1 billon per day in Germany (€ 374,2 billion in 2017) [1]
Between January 2012 and December 2016, we identified 60 German-Diagnosis Related Group (G-DRG) cases of patients who received a Self-expanding Metal Stent (SEMS) and / or Endoscopic Vacuum Therapy (EVT) for esophageal anastomotic leaks
15 patients were excluded because they received a combination of SEMS and EVT
Summary
In 2017, prognostic healthcare expenditures marked approximately € 1 billon per day in Germany (€ 374,2 billion in 2017) [1]. In a single center analaysis an uncomplicated course (Clavien-Dindo) after esophagectomy yielded a slightly positive profit margin of approximately € 2,500 [4]. A common therapeutic endoscopic treatment of an anastomotic leak besides reoperation or conservative treatment is the implantation of a self-expanding metal stent (SEMS), a treatment with a success rate ranging from 69.3% to 91% [8, 9]. Endoscopic vacuum treatment (EVT) has become a promising new alternative for the therapeutic endoscopic treatment of anastomotic leaks as it has a sealing success rate of up to 90% [10]. 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)
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