[Cost-effectiveness analysis of blue light cystoscopy with hexylaminolevulinate in transurethral resection of the bladder]. / Kosten-Effektivitäts-Analyse zur Verwendung der Blaulichtzystoskopie mit Hexylaminolevulinat bei der transurethralen Resektion der Harnblase.

BACKGROUND: Photodynamic diagnosis using the optical imaging agent hexaminolevulinate (HAL, Hexvix®, Ipsen Pharma GmbH, Ettlingen, Germany) as an adjunct to white light cystoscopy (WLC) during the initial transurethral resection of bladder tumours (TURB) improves the detection rate of bladder cancer and leads to fewer recurrences. OBJECTIVES: A cost-effectiveness analysis was carried out in order to calculate the consequences for the German healthcare system. METHODS: We combined a short-term decision tree and a Markov model to evaluate outcomes over a long period of time. The alternatives investigated were HAL-assisted blue light cystoscopy (BLC) as adjunct to WLC (HAL + BLC/WLC) compared with WLC alone in patients undergoing TURB. RESULTS: HAL + BLC/WLC compared to WLC alone was associated with 0.07 incremental quality-adjusted life years (QALYs) and cost savings of 537 € per patient. CONCLUSION: HAL + BLC/WLC compared with WLC alone resulted in both cost savings and improved patient outcome rendering it the "dominant" strategy.

[Inpatient therapy of urinary stones in Germany: development of the G-DRG system]. / Harnsteintherapie im stationären Bereich in Deutschland : Entwicklung des G-DRG-Systems.

BACKGROUND: The therapy of urinary stones in Germany is mostly a domain of hospitals even now. With the introduction of the German diagnosis-related groups (G-DRG) system in the years 2003/2004 an attempt was made to realize an ever-increasing fair representation and remuneration of treatment costs. Simultaneously, a declared target was to transfer all forms of treatment which did not necessitate hospital admission to the outpatient department. RESULTS: Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12% with a parallel increase in the volume of revenues of around 37%. A special feature was a reduction in the proportion of extracorporeal shockwave therapy (ESWL) as inpatient treatment with a parallel increase in the proportion of ureteroscopic and percutaneous interventions.

[Development of the 2014 G-DRG system. Departure from coding of secondary diagnoses?]. / Entwicklung des G-DRG-Systems 2014. Abkehr von der Kodierung der Nebendiagnosen?

The objective of the German DRG (diagnosis-related groups) system is to adequately reimburse hospital costs using flat rate payments. The goal is to thereby achieve the most adequate representation of hospital costs in flat rate payments. The DRG for 2014 is based on the actual number of cases treated and the costs determined from 2012. For 2014, the current changes of the DRG system for the specialty urology concerning the coding and recording of secondary diagnoses are presented and discussed.

[How can the coding quality in the DRG system be determined?]. / Wie kontrolliert man die Kodierqualität im DRG-System?

The permanent adjustments ​​since 2003 to the G-DRG system have made the system even less understandable, so that many users have the feeling of feeding data into a black box which gives them a result without them being able to actively use the system itself. While chief physicians, senior physicians, and nursing managers are responsible to management for the results of the billing, they are in most cases not involved in the steps of DRG coding and billing. From this situation, a common question arises: "How well does my department code?" This uncertainty is exploited by many commercial vendors, who offer a wide variety of approaches for DRG optimization. The goal of this work is to provide advice as to how coding quality can be determined.

[Amendments to the German diagnosis-related groups (G-DRG) system for urology in 2012]. / Veränderungen des G-DRG-Systems für die Urologie im Jahre 2012.

The remuneration system of German diagnosis-related groups (G-DRG) is updated every year in a clearly defined process. This article presents all changes relevant for urologists in 2012.

[Representation of cystectomy and urinary diversion in the G-DRG system 2010: an example for the complexity of the reimbursement system]. / Kodierung der Zystektomie im DRG-System 2010 : Ein Beispiel für die Komplexität des Abrechnungssystems.

Cystectomy and urinary diversion is an excellent example for the growing complexity of the G-DRG (German diagnosis-related groups) system. Based on different diagnoses (malignant tumor of the urinary tract, benign disease of the urinary tract, malignant tumor of the female genital tract, or malignant tumor of the male genital tract), identical cases may lead to very different codes, resulting in even more differences in reimbursement.

[Economic aspects of the treatment of urinary stones. Results of the German Society for Shock Wave Lithotripsy]. / Okonomische Aspekte der Harnsteintherapie. Ergebnisse des Konsensusmeetings der Deutschen Gesellschaft für Stosswellenlithotrypsie (DGSWL).

Urolithiasis is the disease that leads to the largest number of inpatient treatments in urologic clinics in Germany. It is very important to know the current rules of remuneration for urinary stone therapy and to adjust the relevant clinical pathways. The German Society for Shock Wave Lithotripsy (DGSWL) stressed these economic aspects at its 2009 consensus meeting, since clinical therapy cannot be free of economic restrictions in the long term.

[Adjustment of the German DRG system in 2009]. / G-DRG-Systemanpassung 2009.

BACKGROUND: The 2009 version of the German DRG system brought significant changes for urology concerning coding of diagnoses, medical procedures and the DRG structure. In view of the political situation and considerable economic pressure, a critical analysis of the 2009 German DRG system is warranted. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). RESULTS: The relevant diagnoses, medical procedures and German DRGs in the versions 2008 and 2009 were analysed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focus on the development of the DRG structure, DRG validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. CONCLUSION: The German DRG system again gained complexity. High demands are made on correct and complete coding of complex urology cases. The quality of case allocation in the German DRG system was improved. On the one hand some of the old problems (e.g. enterostomata) still persist, while on the other hand new problems evolved out of the attempt to improve the case allocation of highly complex and expensive cases. Time will tell whether the increase in highly specialized DRG with low case numbers will continue to endure and reach acceptable rates of annual fluctuations.

[GreenLight laser therapy for benign prostatic hyperplasia: dilemma of reimbursement in the DRG system]. / Greenlightlaserbehandlung der BPS: Dilemma der Vergütung im DRG-System.

KTP or GreenLight laser vaporization of the prostate has increasingly become an established approach in the last 5 years. Since the additional costs for this treatment were initially not included in the DRG system, there was an extra possibility in 2000-2007 for billing these services as so-called new methods of examination and treatment. Since 2008 there is a new DRG (M11Z) for this procedure, but it does not cover the costs incurred. The reasons for this are to be found in the inhomogeneous assignment of costs by the clinics conducting the calculations. An improved cost reflection can only be expected by concerted action on the part of those hospitals designated as calculators that administer GreenLight laser therapy.

[Calculating the price of a new diagnostic or therapeutic option. Example of transurethral resection of bladder tumors using photodynamic diagnostics with hexaminolevulinic acid]. / Kalkulation einer neuen Untersuchungs- und Behandlungsmethode (NUB). Analyse am Beispiel der PDD-gestützten TUR-B mit Hexaminolävulinsäure.

New diagnostic or therapeutic options (NDTOs) are remunerated separately in the German DRG system. The Institute for Remuneration in Hospitals decides which proposed NDTOs are accepted for separate remuneration for 1 year. With this acceptance, hospitals can enter negotiations with insurance companies for an individual price of the NDTO. Because there are no general recommendations for these negotiations, we present a scheme for how to calculate an NDTO, based on the example of the NDTO for transurethral resection of bladder tumors using photodynamic diagnostic with hexaminolevulinic acid.

[Relevance of hospitals participating in the DRG calculation for the development of the G-DRG system]. / Die Bedeutung der Kalkulationshäuser für die Weiterentwicklung des G-DRG-Systems.

Since the G-DRG system was established for remuneration of inpatient treatment, hospitals may offer the cost data of their cases as a database for the calculation of new DRGs. Therefore, the DRGs will be only as good as the cost data offered. These hospitals must be interested in offering perfect data, since this is the only option to optimize the DRG system.

[Terminology of lower urinary tract dysfunction and coding in the ICD-10-GM catalogue]. / Terminologie der Blasenfunktionsstörungen und Kodierung im ICD-10-GM-Katalog.

The terminology of lower urinary tract dysfunction was recommended by the AWMF and the German Society of Urology in 2004. However, there is no transfer of this terminology to diagnoses according to the classification of the ICD-10-GM catalogue. This catalogue is of major relevance for remuneration of inpatient and outpatient treatment in the German diagnosis-related groups (DRG) system. This article presents a table showing the correspondence between the current terminology and the ICD-10-GM classification. The correct coding can change the DRG remuneration by a factor of 2 to 3.

[The German diagnosis-related groups in urology: reproducibility and quality of coding]. / G-DRG-System für die Urologie : Reproduzierbarkeit und Kodierqualität.

BACKGROUND: The German diagnosis-related group (G-DRG) system is based on the belief that there is only one specific coding for each case. The aim of this study was to compare coding results of identical cases coded by different coding specialists. MATERIAL AND METHODS: Charts of six anonymous cases -- except final letter and coding -- were sent to 20 German departments of urology. They were asked to let their coding specialists do a DRG coding of these cases. The response rate was 90%. RESULTS: Each case was coded in a different way by each coding specialist. The DRG refunding varied by 6-23%. The coding differences were caused by different interpretations of definitions in the DRG system and also by inaccurate chart analysis. CONCLUSION: The present DRG system allows a wide range of interpretation, leading to aggravation of the ongoing disputes between hospitals and insurance companies.

[Structured quality report of urologic clinics according to section 137 SGB V. Useful information for the patient, marketing tool of the hospitals, leverage wielded by the health insurance companies, or junk data?]. / Strukturierte Qualitätsberichte urologischer Hauptabteilungen gemäss 137 SGB V. Entscheidungshilfe für den Patienten, Marketing-Instrument der Kliniken, Druckmittel der Krankenkassen oder Datenmüll?

In 2005, German hospitals were legally obliged to publish a structured quality report on their data of 2004 including the top 10 diagnosis-related groups, top 10 diagnoses, and top 10 procedures for every specialty. The aim was to increase the transparency for patients, doctors, and health insurance companies. Comparing the quality reports of 248 departments of urology revealed very uniform distributions of diagnoses and diagnosis-related groups. There was a large variety of top 10 procedures, resulting from different interpretations of the coding system, leading to diminished accuracy. The quality reports provide coding specialists with important data, but for patients and nonspecialized doctors, this system is not helpful in improving transparency.

[Management of erectile dysfunction after radical prostatectomy. Urologists' assessment vs patient survey responses]. / Versorgung der erektilen Dysfunktion nach radikaler Prostatektomie in Deutschland. Einschätzung durch den Urologen vs. Patientenbefragung.

INTRODUCTION: The aim of this national study was to evaluate ED management after RPX (without any postoperative adjuvant therapy or tumor relapse) from the patient's view compared to the urologist's view. MATERIAL AND METHODS: In May 2003 we queried 1063 urologists and 801 patients following radical prostatectomy without adjuvant therapy. They were asked about preserved potency without erectile aid, existing wish for ED therapy, recommended or tested erectile aid (oral, transurethral, intracorporal, vacuum constriction device[VCD], penile implant) as well as the long-term use. Return rate: patients 80.1%, urologists 26.7%. RESULTS: According to the urologists' view 9.1% of their affected patients were potent postoperatively without a device, but according to the polled patients only 4.7%. The wish to be treated for erectile dysfunction existed in the urologists' opinion in 46.1% of their patients, while they considered that 44.8% had no wish for treatment. On the other hand, 59.3% of the patients would like to be treated and only 28.5% did not want any kind of treatment. Regarding the long-term use of therapy for ED, the urologists thought that 26.1% of their patients did not receive therapy for the problem, and 69.7% of the patients stated they received no long-term therapy. Only 30.3% of the patients confirmed long-term therapy, while the urologists thought that 73.9% of the patients used an erectile aid. Definite therapy in the urologists' opinion involved: oral medication in 38.4%, MUSE in 3.6%, (SKAT) in 37.3%, VCD in 20.4%, and a prosthesis in 0.3%. Indeed 19.8% of the patients used oral medication, 1.7% MUSE, 26.7% SKAT, 50.9% VCD, and 0.9% penile implant. Considering the satisfaction of patients, urologists thought that 46.2% of the patients were satisfied with their treatment of ED, but only 28.9% of the patients were actually satisfied themselves. CONCLUSIONS: The comparison of patients' and urologists' views shows a clearly different description of the ED situation after RPX. The proportion of patients with a wish for treatment and the proportion of dissatisfied patients are much higher from the patients' view. This demonstrates an undertreatment of ED patients after RPX, which should also be taken into account under the current changes in the German health care system.

[Innovative concepts in early cancer detection and staging of localized prostate cancer]. / Innovative Diagnostik in der Früherkennung und beim Staging des lokalisierten Prostatakarzinoms.

Prostate cancer is the most common malignancy in males. Men aged 50 years and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. Fortunately, disease-specific mortality continues to decline as a result of advances in screening, staging, and patient awareness. However, about 30% of men with a clinically organ-confined disease show evidence of extracapsular extension or seminal vesicle invasion on pathological analysis. Consequently, there is a need for more accurate diagnostic tools for planning tailored treatment. A variety of modern imaging techniques has been implemented in an attempt to obtain more precise staging, thereby allowing for more detailed counseling, and instituting optimum therapy. This review highlights developments in prostate cancer imaging that may improve staging and treatment planning for prostate cancer patients.

[Radical prostatectomy for men aged <56 years with prostate cancer. Cost of illness analysis]. / Radikale Prostatektomie bei Männern unter 56 Jahren mit Prostatakarzinom. Eine Krankheitskostenanalyse.

BACKGROUND: Prostate cancer is the most frequent malignant tumor in men; 10% of the patients are younger than 56 years at the time of diagnosis and are usually still working. The aim of this study was to evaluate the costs of the disease within the first 3 years from diagnosis. MATERIAL AND METHODS: A total of 200 patients (aged <56 years) after radical prostatectomy with curative intent were asked for their social status, professional training and job before and after radical prostatectomy, disablement, length of hospital stay, rehabilitation, early retirement, part-time retirement, retraining program, job-creating measures, and working conditions after radical prostatectomy. RESULTS: Of the 200 patients queried, 177 (88.5%) answered the questionnaire. Prior to the radical prostatectomy 163 patients were employed. They were off work for a mean time of 104.4 days, 83.4% of them received inpatient rehabilitation treatment after surgery, 121 (74.2%) regained full fitness for work, 9 (5.5%) retired on grounds of age, 21 (12.9%) had an early retirement because of the disease, and 12 (7.4%) became unemployed. Within the first 3 years after diagnosis, the following mean costs had to be paid: 465.79 by the patient, 6569.76 by the employer, 16,356.96 by the health insurance, 13,304.88 by the pension scheme, and 3912.57 by the employment office. CONCLUSION: The main costs in patients with prostate cancer and radical prostatectomy have to been paid by the health insurance scheme and the pension scheme; 74.3% of the patients regained full fitness for work. The time until reintegration into work was correlated to the extent of physical labor.

Assessment of a fragment of e-cadherin as a serum biomarker with predictive value for prostate cancer.

In prostate cancer, biomarkers may provide additional value above standard clinical and pathology parameters to predict outcome after specific therapy. The purpose of this study is to evaluate an 80 kDa fragment of the cell adhesion molecule e-cadherin as a serum biomarker. A broad spectrum of prostate cancer serum samples, representing different stages of prostate cancer disease, including benign prostatic hyperplasia (BPH), localised (Loc PCA) and metastatic prostate cancer (Met PCA), was examined for the cleaved product. There is a significant difference in the expression level of the 80 kDa fragment in the serum of healthy individuals vs patients with BPH and between BPH vs Loc PCA and Met PCA (P<0.001). Highest expression levels are observed in advanced metastatic disease. In the cohort of Loc PCA cases, there was no association between the 80 kDa serum concentration and clinical parameters. Interestingly, patients with an 80 kDa level of >7.9 microg l(-1) at the time of diagnosis have a 55-fold higher risk of biochemical failure after surgery compared to those with lower levels. This is the first report of the application of an 80 kDa fragment of e-cadherin as a serum biomarker in a broad spectrum of prostate cancer cases. At an optimised cutoff, high expression at the time of diagnosis is associated with a significantly increased risk of biochemical failure, potentially supporting its use for a tailored follow-up protocol for those patients.

[Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology]. / Anmerkungen zur Einführung der Deutschen Diagnosis-related Groups (G-DRGs) für das Fach Urologie.

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way. Tools for an optimized coding must be a coding manual created for the specific needs of urologists and an infrastructure that allows a permanent quality control for all persons involved.