[Embolization of intracranial aneurysms: reimbursement and perspectives]. / Embolisations des anévrismes cérébraux: évolutions du financement et perspectives.

PURPOSE: To determine the costs related to the embolization of intracranial aneurysms compared to "rates per activity" (T2A) reimbursements. MATERIALS AND METHODS: The hospital admissions of patients with intracranial aneurysms treated with embolization and classified under diagnosis-related group (DRG) 01K02Z in 2007 were included. The costs related to the single-use devices, neurointerventional suite and hospital stay were calculated by analytical accounting. Revenues were calculated based on DRG-based medical information system (PMSI) and medical data using the diagnosis-related groups and reimbursements from 2007 (V10 of DRG) and 2009 (V11). RESULTS: Fifty-seven patients were included. The total cost was 932.278 euro and hospital revenues were 655.648 euro in 2007 and would have been 825.211 euro in 2009. The financial loss was on average 4.853 euro per admission in 2007 and 1.878 euro in 2009, and even more in two cases of ruptured aneurysm. CONCLUSION: In 2001, embolization of intracranial aneurysms, the treatment of choice for this pathology, results in a financial loss for the hospital, larger for ruptured aneurysms compared to non-ruptured aneurysms. The updated DRG, while improving the situation, remains insufficient.

Cost analysis in total hip arthroplasty: experience of a teaching medical center located in Paris.

BACKGROUND: Since the beginning of 2008, the implementation of a 100% activity-based payment system, has made efficiency one of the prime concern for the French health-care providing institutions. We therefore assessed the real cost of a scheduled total hip replacement (THR) ina teaching hospital and compared findings with French national data (and with the Government Healthcare Insurance System allowance). HYPOTHESIS: The study should suggest possible means to optimize organization of management and/or clinicians' practice. MATERIAL AND METHODS: This is a retrospective full-cost economic study. Patients were included only if fulfilling the following criteria: admitted in 2006; classified in Diagnosis-Related Group (DRG) 08C23 V or 08C23W (respectively THR without and with associated comorbidity); treated in a single department; admitted from home; and having undergone a THR (coded as NEKA020 in the french CPT) that same year. Treatment-cost was established on the basis of data collected from two main sources: the Information Systems Medicalization Program (ISMP) data-base, and the finance department data, which were taken into account in line with the French National Costs Study (NCS) structure. RESULTS: The methodology employed here follows the 2006 National Costs Scale structure. Treatment costs (excluding the cost of implantable medical devices or IMDs) were estimated at 8,104.72 EUR for DRG 08C23W and 7,529.19 EUR for DRG 08C23 V. These figures were higher than the rates authorized in 2006 (excluding IMDs), which were 7,677.92 EUR for 08C23W and 6,358.97 EUR for 08C23 V (taking the 7% geographic coefficient into account) and than the 2005 NCS figures (excluding IMDs) of respectively 7,536.13 EUR and 6,083.59 EUR. DISCUSSION: Clinical units and departments need to be able to assess costs for the pathologies they treat, as health-care institutions have to balance their expenditure against their income, which largely comes from their hospital-care activity. The methodology put forward here, of cost comparison according to the NCS structure, enables the total cost to be known. Comparing results (expenditure line by expenditure line) against national data, selectively highlights the areas in which efficiency can be improved. The exactitude of the obtained results remains, however, limited by the rules currently in use at each individual hospital's accounting department. LEVEL OF EVIDENCE: Level IV, retrospective economic and decision analysis study.

[Payment by activity and financing of innovative hospital procedures: does the new payment system cover endovascular treatment for cerebral aneurysms?]. / Financement des traitements endovasculaires des anévrysmes cérébraux. La tarification à l'activité permet-elle aux établissements de santé de financer la prise en charge des patients?

METHOD: We have calculated all hospital expenses related to treated intracerebral aneurysms for 2005. Catheters, microcatheters, and guidewires as well as coils were included. We have compared these expenses to the payment by activity and fee per service collected for providing these services. RESULTS: Payments received covered only a third of the expenses for the supplies used. Three types of expenses are not reimbursed: the guiding material, the coils used but not released, and the latest generation of coils not yet added to the national list of covered devices. These expenses are also not covered by the payment received for the hospital admission. DISCUSSION: Endovascular management of intracranial aneurysms has become the treatment of choice over the recent years. This treatment is virtually only available in university hospitals. With the current mode of reimbursement, such treatment generates losses to the hospital. CONCLUSION: This example raises the question of financial support for innovative treatments and procedures.