Diagnostic Related Groups Research Articles

PSU16 ESTIMATING THE CLINICAL AND ECONOMIC IMPACT OF IMPLEMENTING PREOPERATIVE ANEMIA MEASURES IN THE GERMAN HEALTHCARE SYSTEM: THE HEALTH ECONOMIC FOOTPRINT OF PATIENT BLOOD MANAGEMENT (PBM)

The implementation of preoperative anemia measures, first pillar of the Patient Blood Management programme (PBM), is associated with improved patient outcomes, reduced rates of blood transfusions and reduction of hospital costs. The aim of this study is to estimate the clinical and economic impact of addressing iron deficiency anemia in preoperative elective surgery patients in the German health system. A well-known German healthcare database (DRG-Statistik, 2015) is used to extract and analyze data from 4.6 million elective surgery patients. We estimate the patient outcomes and the potential direct hospital cost-savings of implementing preoperative anemia measures in Germany. The analysis of the clinical characteristics (ICD-10-GM) and the Diagnostic Related Groups (DRGs) from the German database allows to identify and allocate groups of patients and their costs on the basis of two risk factors: Iron Deficiency Anemia and risk of undergoing blood transfusions. A health economics model estimates the clinical benefits (avoided deaths) and potential net cost-savings of identifying and treating a target population of preoperative iron deficiency anemia patients in the German healthcare system. The implementation of effective preoperative anemia measures, which would account for an investment of 10.4 million € in Germany, to both diagnosed and undiagnosed elective surgery iron deficiency anemia patients yields the following outcomes: 2,773 avoided hospital deaths per year; 528,531 avoided hospital days per year; and a net potential hospital direct cost-savings of 914 million € per year in Germany. This study shows that implementing preoperative anemia measures, the first pillar within the Patient Blood Management programme (PBM), represents an efficient public health intervention. In short, in the German healthcare system it would lead to the prevention of deaths and a net potential direct hospital costs-savings of 914 million € which account for 1.4% of the total hospital costs in Germany.

Standardizing community benefit between not-for-profit and investor-owned hospitals

ABSTRACT This research investigates whether investor-owned (IO) hospitals provide equivalent charity care as not-for-profit (NFP) hospitals in a reduced uncompensated care environment (post Affordable Care Act). Gross revenues, Total Uncompensated Charges (TUC), and a new measure, Standardized Patient Service Benefits (SPSB), are computed for not-for-profit and investor-owned hospitals. The SPSB is calculated based on Diagnostic Related Groups (DRGs) for each discharge and does not allow for local hospital price manipulation. This eliminates pricing differences between hospitals for similar services when evaluating charity care. Using patient discharges classified as charity care, IO hospitals appear to provide more charity care than NFP hospitals when measuring by the TUC. When the TUC is adjusted for the corresponding DRG value (SPSB), the amount of charity care for not-for-profit hospitals exceeds investor-owned hospitals, a reversal from the TUC results. This research adds to the existing body of knowledge by introducing a new standardized measure, SPSB. This method eliminates pricing differences and may be used for ownership comparisons when hospitals charge varying amounts for similar services. Additionally, the results indicate that revenue manipulation may inflate the perceived amount of charity care and potential tax benefit.

P6213The influence of working-age on attendance to cardiac rehabilitation: a gender comparison

Abstract Introduction Despite guidelines recommending referral to cardiac rehabilitation (CR), attendance remains poor. Literature cites a complexity of clinical, psychological and social factors as barriers to CR attendance and, females may attend less than males. Social factors including work commitments, may influence attendance, with many Australian CR programs offered during office hours, making access difficult. The Australian retirement age for females and males differs; (females >60 years and males >65 years). We hypothesised that working-age may influence attendance to CR. Purpose In a CR-referred population this study sought to compare working-age of males and females and the association with CR attendance. Methods Data from 24 country and metropolitan CR services between 2013 and 2015 were linked to 49,909 CR-eligible patients defined as, discharged alive with a primary cardiac-related diagnosis and/or interventional procedure, identified through public hospital administrative data (Figure). Only CR-referred patients were included, with males and females categorised by three age groups: <60, 60–65 and >65 years, comparing attendance in univariate analysis. Adjustment for clinical and psychological (International Classification of Disease-10 Australian Modification mental health diagnostic-related group diagnoses) factors were conducted using multi-logistic regression. Results Between 2013–2015, 15,089 patients were referred to CR with 4,819 <60 years, 1,943 between 60–65 years and 8,327 >65 years. Of referrals a total of 4,286 (28.4%) attended CR, 1134 (35%) of whom were female. Univariate analysis observed total attendance by age group ranged between 26–32%, with females less likely to attend than males (<60 years; 25.3% v 32.2%, p<0.001, 60–65 years; 29.5% v 33.2%, p=0.130 and >65 years; 23.2% v 23.6%, p<0.001). Multivariate analysis observed more attendance in the 60–65 years group compared to <60 years (odds ratio (OR): 1.15 [95% confidence interval [CI]: 1.00–1.32], p=0.036) with females less likely to attend than males (OR: 0.81, [95% CI; 0.70–0.95], p=0.009). No interaction between the working age classification and gender were observed. Conclusion In an Australian cohort, working-age observed no influence on cardiac rehabilitation program attendance, with the period of female retirement age observing a 19% reduction in attendance. Further research on the complexity of factors that may be barriers to attendance is essential to evaluate how to improve cardiac rehabilitation programs to better suit the needs of our cardiac patients. Acknowledgement/Funding Flinders University partnership grant and South Australian Department of Health Local Health Networks

Hemorrhage in patients under oral anticoagulation for atrial fibrillation. The other side of the coin

Introduction and objectivesOral anticoagulation therapy is prescribed to most patients with atrial fibrillation. The main limitation of anticoagulant treatment is the occurrence of bleeding episodes. We sought to assess the type of hemorrhages and mortality in patients anticoagulated for nonvalvular atrial fibrillation. MethodsObservational retrospective study analyzing 2081138 hospitalization reports from 2014 corresponding to 151 hospitals of the Spanish National Health System. Patients were selected with the diagnosis of hemorrhage, nonvalvular atrial fibrillation, and oral anticoagulation. ResultsA total of 5783 hospitalizations were analyzed. Most hemorrhages were digestive (43.6%), followed by cerebral (30.6%). Among the digestive, only 27% were high. Mean age was 79.8 years, 57.1% were males, the mean hospital stay was 7.7 days. Complexity assessed by the mean diagnostic related group was 2.39 (versus 1.83 of the total hospitalizations). In-hospital mortality was 15.2% versus 10.8% of the hospitalization for hemorrhages and 3.9% of the total hospitalizations (P<.05). ConclusionsHemorrhages in patients anticoagulated for nonvalvular atrial fibrillation have a high sociosanitary impact. The most frequent hemorrhages were digestive, only a fourth part of them was high. A third of hemorrhages were cerebral. In-hospital mortality in this population was high.

Budget impact analysis of the new reimbursement policy for day surgery in Thailand.

IntroductionIn 2017 the Thai Ministry of Public Health proposed a new financing mechanism to promote day surgery under the Universal Coverage Scheme – the main public insurance arrangement for Thais. The key feature of the policy is health facilities performing day surgery can claim the treatment expense based on relative weight (RW) instead of adjusted RW (adjRW). Procedures for 12 diseases (so-called “candidate procedures”) are eligible for the new reimbursement. The objective of this study was to assess the current day surgery situation in Thailand and analyze potential budget impact from the new policy.MethodsA quantitative cross-section design was employed. Individual inpatient records of the Universal Coverage Scheme during 2014–2016 were analyzed. Descriptive statistics and simulation analyses were applied. The analyses were divided into three subtopics: 1) case volume and expense claim, 2) utilization across facilities, and 3) case mix index and budget impact.ResultsOverall, day surgery accounted for 4.8% of admissions with candidate procedures. Inguinal hernias, hemorrhoids, and common bile duct stones caused the largest sum of admission numbers and admission days. Currently, the annual reimbursement for candidate procedures treated as inpatient cases is around 290.8 million Baht (US$ 8.8 million), with about 12.4 million Baht (US$ 0.38 million) for day surgery cases. If all candidate procedures were performed as day surgery and diagnostic-related groups (DRG) version 6 was applied, the incremental budget would amount to 1.9 million Baht (US$ 58,903).ConclusionsThe new reimbursement policy will likely lead to minimal budget burden. Even in the case of maximal uptake of the policy, the needed budget would increase by just 15%. The marginal budget increment was explained by the infinitesimal RW–adjRW difference. Apart from the financial measure, other qualitative aspects of the policy, such as infrastructure and health staff readiness, should be explored.

Technocratic recentralization in the French health care system: A critical evaluation.

The French health care system implemented several corporate management recipes such as diagnostic-related groups (DRGs), benchmarking, and activity-based management in a bid to restore fiscal discipline and to "reassert the center." The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top-down line of command to ensure policy implementation. Though reforms emphasized evidenced-based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society.

Analysis of Hospital Mortality Data: The Role of DRG’s

Background: Factors associated with hospital mortality are usually identified and their effects are quantified through statistical modeling. To guide the choice of the best statistical model, we first quantify the predictive ability of each model and then use the CIHI index to see if the hospital policy needs any change. Objectives: The main purpose of this study compared three statistical models in the evaluation of the association between hospital mortality and two risk factors, namely subject’s age at admission and the length of stay, adjusting for the effect of Diagnostic Related Groups (DRG). Methods: We use several SAS procedures to quantify the effect of DRG on the variability in hospital mortality. These procedures are the Logistic Regression model (ignoring the DRG effect), the Generalized Estimating Equation (GEE) that takes into account the within DRG clustering effect (but the within cluster correlation is treated as nuisance parameter), and the Generalized Linear Mixed Model (GLIMMIX). We showed that the GLIMMIX is superior to other models as it properly accounts for the clustering effect of “Diagnostic Related Groups” denoted by DRG. Results: The GLM procedure showed that the proportional contribution of DRG is 16%. All three models showed significant and increasing trend in mortality (P < 0.0001) with respect to the two risk factors (age at admission, and hospital length of stay). It was also clear that the CIHI index was not different under the three models. We re-estimated the models parameters after dichotomizing the risk factors at the optimal cut-off points, using the ROC curve. The parameters estimates and their significance did not change.

Public Key Authenticated Encryption With Designated Equality Test and its Applications in Diagnostic Related Groups

Due to the massive growth of data and security concerns, data of patients would be encrypted and outsourced to the cloud server for feature matching in various medical scenarios, such as personal health record systems, actuarial judgments and diagnostic related groups. Public key encryption with equality test (PKEET) is a useful utility for encrypted feature matching. Authorized tester could perform data matching on encrypted data without decrypting. Unfortunately, due to the limited terminology in medicine, people within institutions may illegally use data, trying to obtain information through traversal methods. In this paper we propose a new PKEET notion, called public-key authenticated encryption with designated equality test (PKAE-DET), which could resist this kind of attacks launched by an inside adversary, known as offline message recovery attacks (OMRA). We propose a concrete construction of PKAE-DET, which only requires one single server to perform the feature matching job securely, and does not require any group mechanism. We prove its security based on some simple mathematical assumptions. Experimental results show that our scheme has efficiency comparable with those PKEET schemes which do not resist OMRA attacks or require group mechanism. We further show how our scheme could be effectively used in diagnostic related groups in medicine, demonstrating its practicability.

Focused Resident Education and Engagement in Quality Improvement Enhances Documentation, Shortens Hospital Length of Stay, and Creates a Culture of Continuous Improvement

System-based practice with an emphasis on quality improvement (QI) is a recent initiative for the American College of Surgeons and a core-competency for surgical trainees. Few surgical training programs have a curriculum for hospital-based QI. Our vascular surgery service implemented several QI initiatives focused on decreasing length of stay (LOS) by targeting resident education and engagement. Residents were educated on terminology and processes impacting hospital and CMS QI metrics such as Medicare geometric mean LOS (CMS GMLOS) and diagnostic-related groups (DRG) with complication or comorbidity (CC/MCC) coding. LOS initiatives focused on identifying, tracking and removing avoidable perioperative delays, and improving accuracy of clinical documentation. Residents were given specific roles in QI initiatives and the impact on LOS was quantified. Patients' CMS GMLOS were compared to actual LOS during daily rounds, with confirmation that resident progress notes contained thorough and accurate documentation of diagnoses, comorbidities, and complications. Ten minutes during weekly preoperative conferences were dedicated to ongoing QI, with LOS metrics for the inpatient census presented by trainees and reviewed by attendings. Feedback was given addressing barriers to avoidable delays and impact on LOS. Data for July 2016-June 2017 (FY17) was compared to preimplementation baseline data (FY16) for vascular discharges overall. Accurate documentation of acuity was evaluated with in-depth review of notes and overall case mix index. Within the first year of implementation, overall vascular admissions demonstrated a 21% reduction in LOS, closing the gap between observed LOS and expected CMS GMLOS, from 2.1days to 0.5days on average. Documentation improved, with a shift in 24% of DRGs to accurately reflect CC/MCC. Overall case mix index increased by 10%, from 3.07 to 3.37. A culture of continuous quality improvement can be created with the establishment of a QI infrastructure that educates and involves trainees as stakeholders. Assigning discrete roles to increase resident accountability supports both formal and informal resident education that can substantially impact hospital benchmarking metrics.

Cost-effectiveness analysis of single use negative pressure wound therapy dressings (sNPWT) compared to standard of care in reducing surgical site complications (SSC) in patients undergoing coronary artery bypass grafting surgery

BackgroundThere is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures.ObjectivesTo estimate the cost-effectiveness of single use negative pressure wound therapy (sNPWT) compared to standard of care in patients following coronary artery bypass grafting surgery (CABG) procedure to reduce surgical site complications (SSC) defined as dehiscence and sternotomy infections.MethodA decision analytic model was developed from the Germany Statutory Health Insurance payer’s perspective over a 12-week time horizon. Baseline data on SSC, revision operations, length of stay, and readmissions were obtained from a prospective observational study of 2621 CABG patients in Germany. Effectiveness data for sNPWT was taken from a randomised open label trial conducted in Poland which randomised 80 patients to treatment with either sNPWT or standard care. Cost data (in Euros) were taken from the relevant diagnostic related groups and published literature.ResultsThe clinical study reported an increase in wounds that healed without complications 37/40 (92.5%) in the sNPWT compared to 30/40 (75%) patients in the SC group p = 0.03. The model estimated sNPWT resulted in 0.989 complications avoided compared to 0.952 and the estimated quality adjusted life years were 0.8904 and 0.8593 per patient compared to standard care. The estimated mean cost per patient was €19,986 for sNPWT compared to €20,572 for SC resulting in cost-saving of €586. The findings were robust to a range of sensitivity analyses.ConclusionThe sNPWT can be considered a cost saving intervention that reduces surgical site complications following CABG surgery compared to standard care. We however recommend that additional economic studies should be conducted as new evidence on the use of sNPWT in CABG patients becomes available to validate the results of this economic analysis.

Оптимизация расходов на стационарную медицинскую помощь пациентам, перенесшим операции на органах брюшной полости и нуждающимся во введении селективных антидотов миорелаксантов

The article thoroughly considers the algorithm of substantiation of tariff changes for completed cases paid at the expense of obligatory health insurance by diagnostic-related groups on the level of Russian regions. The analysis is performed on the example of patients, who need fast recovery of neuromuscular conductivity after administration of muscle relaxants during abdominal surgical operations including cholecystectomy. The data from the official statistical report forms on the number of abdominal surgical interventions for 2005–2017 were used. The results on the frequency of the use of muscle relaxants were based on the data obtained from medical organizations in different regions of Russia. The analysis of the procurement of muscle relaxants was performed using the data from the analytical system for monitoring of such procurement.

Design and effects of outcome-based payment models in healthcare: a systematic review

IntroductionOutcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects.MethodsWe first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs.ResultsWe included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth.DiscussionAlthough strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.

Professional competences, clinical management and diagnostic related groups in Chilean public hospitals

To define a professional skills model for the creation of an information system to support clinical management based on diagnosis related groups (DRG) in Chilean public hospitals. Mixed methodology. Qualitative, descriptive research based on focused interviews, with a theoretical or intentional sample of four leading DRG experts from Chile, with content analysis. Quantitative research using the Delphi method on 18 managers in charge of the implementation of DRG units in Chile, with three rounds. The analysis of quantitative data was carried out by clusters. After five iterations, 78 skills were evaluated out of a total of 179 as "high", including knowledge of the team leader, professional training (preferably nurses), 15 attitudes and values, 17 skills and 12 specific skills related to the coding system. There is a tendency among professionals to require the maximum skills; a massive behavior was observed, with low discrimination and prioritization. To analyze the causes that make decision-making difficult and to prioritize the required skills is proposed to determine the necessary level for each skill, the gaps between skill offer and demand, and to design a system for evaluating the impact of the model on the development of the skills among the teams.

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

BackgroundUnderstanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation. MethodsWe assessed patient, payer, and clinical characteristics of nationally-representative 2011–2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis. ResultsAnnual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges). ConclusionsNow nearly half a million yearly US hospital discharges for a range of primary treatment include patients' diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.

Complex treatments in rheumatology and geriatrics - Challenges - Differences - Chances

With the introduction of the German diagnostic-related groups (G-DRG) system in 2003, remuneration according to DRG was also implemented for the disciplines of rheumatology and geriatrics. For acute inpatient treatment in the field of rheumatology the specialized complex rheumatological treatment (OPS code8-983) and the related DRG-I97Z (rheumatological complex treatment for diseases and disorders of the musculoskeletal system and connective tissue) were assigned to the DRG system in 2005 and 2006, respectively. The early complex geriatric rehabilitation (OPS code8-550) is atool in the treatment of older patients affected by rheumatism. In this article the challenges of realizing complex therapies are described using the examples of OPS code8-983 and8-550 and their structural and procedural differences are outlined. Acute inpatient treatment of patients severely affected by arheumatic disease as well as of multimorbid geriatric patients with rheumatism is supported by the implementation of the respective complex therapy.

Make the Payer a Player on the Transition Team

Make the Payer a Player on the Transition Team

Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk.

The All Patient Refined Diagnosis Related Group (APR-DRG) is an inpatient visit classification system that assigns a diagnostic related group, a Risk of Mortality (ROM) subclass and a Severity of Illness (SOI) subclass. While extensively used for cost adjustment, no study has compared the APR-DRG subclass modifiers to the popular Charlson Comorbidity Index as a measure of comorbidity severity in models for perioperative in-hospital mortality. In this study we attempt to validate the use of these subclasses to predict mortality in a cohort of surgical patients. We analyzed all adult (age over 18years) inpatient non-cardiac surgery at our institution between December 2005 and July 2013. After exclusions, we split the cohort into training and validation sets. We created prediction models of inpatient mortality using the Charlson Comorbidity Index, ROM only, SOI only, and ROM with SOI. Models were compared by receiver-operator characteristic (ROC) curve, area under the ROC curve (AUC), and Brier score. After exclusions, we analyzed 63,681 patient-visits. Overall in-hospital mortality was 1.3%. The median number of ICD-9-CM diagnosis codes was 6 (Q1-Q3 4-10). The median Charlson Comorbidity Index was 0 (Q1-Q3 0-2). When the model was applied to the validation set, the c-statistic for Charlson was 0.865, c-statistic for ROM was 0.975, and for ROM and SOI combined the c-statistic was 0.977. The scaled Brier score for Charlson was 0.044, Brier for ROM only was 0.230, and Brier for ROM and SOI was 0.257. The APR-DRG ROM or SOI subclasses are better predictors than the Charlson Comorbidity Index of in-hospital mortality among surgical patients.

A decision aiding methodology to compare patient classification systems

Spanish public hospitals funding depends on the classification of attended pathologies. These pathologies are grouped thanks to a patient classification system (PCS) into the so-called diagnostic related groups (DRGs). International Classification of Diseases (ICD) coding systems generate various DRGs. Based on the ICD-9, the all patients diagnostic related groups (AP-DRGs) were used. In January 2016, Spain adopted ICD-10. One of the casualties from this transition was the AP-DRG PCS which did not accept information coded with ICD-10. A new system had to be adopted. In this paper we develop a methodology to assist decision-makers who are charged with evaluating and determining replacement PCS in the context of scarce resources and limited hospital funding. We ground our approach in a rigorous analytical framework is order to understand the pros and cons of candidate systems, from both clinical and managerial perspectives. We propose a multicriteria decision-aiding approach based on the outranking method, ELECTRE III to produce a ranking of the different options. The methodology is applied to a case study of a Spanish hospital where the change from ICD-9 to ICD-10 has already occurred.

Cost Savings of Perioperative Anemia Treatment with Ferric Carboxymaltose In Colorectal Cancer Surgery Patients

Pre-operative anemia, commonly associated with iron deficiency (IDA), occurs in approximately 30% of patients undergoing surgery. Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce the need for red blood cell concentrate (RBC), surgical complications, mortality and the hospital length of stay (LOS) in patients with preoperative IDA. The objective of this study is to model the cost impact of peri-operative IDA treatment with FCM vs. usual care prior to colorectal cancer surgery in the French health care setting. The model used is based on the results of a RCT by Froessler et al. comparing FCM vs. usual care in abdominal surgery mostly colorectal cancer surgery patients (73% in FCM group and 85% in usual care group). Reported reduction in RBC transfusion (12.5% vs. 31.5%) and LOS (6 days vs. 9) were used as clinical metrics of the model. Cost parameters for hospitalization are based on the French Diagnostic-Related Groups (DRG) and for hospital activity on the French national hospitalizations database (PMSI). DRG were identified based on the CIM-10 diagnosis for colorectal cancer (C18). The study sample was extrapolated to a cohort size of 100 patients. The model was adapted to a Health Insurance perspective. One-way sensitivity analyses (OWSA) were undertaken. A total of 20 485 hospital stays for CRC resection were extracted from the PMSI database. Results from the model suggests that peri-operative IDA treatment with FCM reduces the overall costs in a cohort of 100 patients from € 570,373 to € 426,358, corresponding to potential savings of €144,015. Sensitivity analysis showed that LOS and cost per day in hospital ward were the main cost drivers. Peri-operative IDA treatment with FCM in CRC surgery could lead to significant cost savings based on a reduction in blood transfusion and length of stay.

ASSESSMENT OF THE CURRENT ECONOMIC EFFICIENCY OF TREATMENTOF PATIENTS WITH OSTEOARTHRITIS IN SAINT-PETERSBURG AND ITS PERSPECTIVES

The article analyzed the features of the existing system of treatment’s payment in patients with osteoarthritis. The main features of the billing during the transition of the patients hospitalization pay- ment to the system using diagnostic-related groups defines. The main advantages and disadvantages of these systems are analyzed, ways of the economic results optimization of osteoarthritis patients treat- ment are determined with in connection with the planned transition to payment using the clinical- statistical groups. Presented method of the economic efficiency evaluation of paying for treatment can be recommended for use in any other nosological forms of diseases.