Clinical Management Support Department, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
J Heart Lung Transplant. 2010 Jan;29(1):72-8. doi: 10.1016/j.healun.2009.06.029. Epub 2009 Sep 26.
The purpose of this study was to compare and contrast total hospital costs and subsequent reimbursement of implementing a new program using a third-generation left ventricular assist device (LVAD) in Norway.
Between July 2005 and March 2008, the total costs of treatment for 9 patients were examined. Costs were calculated for three periods-the pre-implantation LVAD phase, the LVAD implantation phase and the post-implantation LVAD phase-as well as for total hospital care. Patient-specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging, and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by pre-defined allocation keys. Finally, patient-specific costs and overhead costs were aggregated into total patient costs.
The average total patient cost in 2007 U.S. dollars was $735,342 and the median was $613,087 (range $342,581 to $1,256,026). The mean length of stay was 77 days (range 40 to 127 days). For the LVAD implantation phase, the mean cost was $457,795 and median cost was $458,611 (range $246,239 to $677,680). The mean length of stay for the LVAD implantation phase was 55 days (range 25 to 125 days). The diagnosis-related group (DRG) reimbursement (2007) was $143,192.
There is significant discrepancy between actual hospital costs and the current Norwegian DRG reimbursement for the LVAD procedure. This discrepancy can be partly explained by excessive costs related to the introduction of a new program with new technology. Costly innovations should be considered in price setting of reimbursement for novel technology.
本研究旨在比较和对比挪威实施第三代左心室辅助装置（LVAD）新方案的总医院成本和后续报销情况。
2005 年 7 月至 2008 年 3 月期间，对 9 名患者的治疗总成本进行了检查。成本分为三个时期进行计算——LVAD 植入前阶段、LVAD 植入阶段和 LVAD 植入后阶段——以及总医院护理费用。从患者记录中前瞻性地获得患者特定成本，包括人员资源、药物、血液制品、血液化学和微生物学、影像学以及包括手术室成本在内的手术成本。间接成本是通过预定义的分配键回顾性登记并分配给特定患者的。最后，将患者特定成本和间接成本汇总为总患者成本。
2007 年以美元计的平均总患者成本为 735342 美元，中位数为 613087 美元（范围为 342581 美元至 1256026 美元）。平均住院时间为 77 天（范围为 40 天至 127 天）。LVAD 植入阶段的平均成本为 457795 美元，中位数成本为 458611 美元（范围为 246239 美元至 677680 美元）。LVAD 植入阶段的平均住院时间为 55 天（范围为 25 天至 125 天）。诊断相关组（DRG）报销（2007 年）为 143192 美元。
LVAD 手术的实际医院成本与挪威现行 DRG 报销之间存在显著差异。这种差异部分可以解释为与新技术引入相关的过高成本。在为新技术制定报销价格时，应考虑昂贵的创新。
