Muazzam Muhammad Nur, Hauk Christopher, Arensmeyer Jan, Hausen Annekristin, Koeppen Philipp, Kalff Jörg C, von Websky Martin W
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Germany.
Medizinmanagement, Universitätsklinikum Bonn, Germany.
Z Gastroenterol. 2020 Apr;58(4):364-372. doi: 10.1055/a-1072-5349. Epub 2020 Apr 30.
Short-bowel-syndrome (SBS) is an often chronic disease with high morbidity. The aim of this study was to evaluate the complexity of SBS treatment and the economic burden on a treating hospital.
Anonymized data of eleven consecutive SBS patients from the University Hospital of Bonn were included. Parameters of medical resources were considered for year of diagnosis (YOD) and a follow-up (FU) period of three years. Subsequently, costs were evaluated according to the corresponding catalogues.
Median inpatient days were 96 days in YOD and decreased to three days in the third year of FU. Median cost of inpatient treatment decreased from approximately 84 500 € auf 3200 €. While major visceral surgery was usually required in the YOD, catheter-associated interventions dominated during further FU. Actual reimbursement according to the G-DRG covered approximately 50 % of inpatient treatment cost, for outpatient care only est. 16.5 % of costs were covered. Annual costs for medication, parenteral nutrition and GLP-2-analogon treatment added up to 6752 €, 48 485 € and 138 442 €, respectively.
The interdisciplinary medical care of SBS-patients is resource-intensive and expensive. The required treatment shifts from the in- to the outpatient sector. Both settings are at present not adequately reimbursed. Hence, this imbalance may endanger adequate care for SBS-patients in the future in times of economic rationale. In concordance with other rare disease management programs, additional measures are needed to provide and improve interdisciplinary treatment of SBS.
短肠综合征（SBS）是一种常见的慢性病，发病率很高。本研究的目的是评估SBS治疗的复杂性以及治疗医院的经济负担。
纳入了来自波恩大学医院的11例连续SBS患者的匿名数据。考虑了诊断年份（YOD）和三年随访期（FU）的医疗资源参数。随后，根据相应目录评估成本。
YOD的住院天数中位数为96天，在FU的第三年降至3天。住院治疗的中位数成本从约84500欧元降至3200欧元。虽然在YOD通常需要进行 major visceral surgery，但在进一步的FU期间，与导管相关的干预占主导地位。根据G-DRG的实际报销约占住院治疗成本的50%，门诊护理仅估计报销成本的16.5%。药物、肠外营养和GLP-2类似物治疗的年度成本分别总计6752欧元、48485欧元和138442欧元。
SBS患者的跨学科医疗护理资源密集且昂贵。所需治疗从住院部门转向门诊部门。目前这两种情况的报销都不足。因此，在经济理性的时代，这种不平衡可能会危及未来SBS患者的充分护理。与其他罕见病管理项目一致，需要采取额外措施来提供和改善SBS的跨学科治疗。
