Mohr Katharina, Hobohm Lukas, Kaier Klaus, Farmakis Ioannis T, Valerio Luca, Barco Stefano, Abele Christina, Münzel Thomas, Neusius Thomas, Konstantinides Stavros, Binder Harald, Keller Karsten
Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Clin Res Cardiol. 2024 Apr 2. doi: 10.1007/s00392-024-02437-y.
The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany.
We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0 days).
We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.
急性肺栓塞（PE）给欧洲医疗系统带来的社会经济负担很大程度上尚不清楚。我们试图确定德国PE住院治疗的时间趋势并找出成本驱动因素。
我们分析了2016年至2020年德国报销的全部住院费用（G-DRG系统）。在此期间，共编码了484884例PE住院病例。直接住院费用中位数为3572欧元（四分位距，2804至5869欧元），每年平均总报销额为7.1亿欧元。通过多变量逻辑回归确定年龄、PE严重程度、合并症和院内（尤其是出血）并发症是显著的成本驱动因素。导管导向治疗（CDT）的使用持续增加（接受CDT治疗的住院病例绝对比例的年变化为+0.40%[95%置信区间+0.32%至+0.47%]；P<0.001），随着时间的推移，重度PE患者组（占全部患者的28%）中该比例增加了一倍多。尽管总体而言，使用CDT与住院费用增加相关，但在重度PE和休克患者中，这种关联不再存在（调整后的比值比为1.02[0.80 - 1.31]）；这至少部分与住院时间中位数缩短有关（从14.0天降至8.0天）。
我们确定了PE住院治疗当前和新出现的成本驱动因素，重点关注严重疾病以及早期不良结局的中/高风险。本研究可为政策制定者的报销决策提供参考，并有助于指导未来对PE患者高级治疗方案的卫生经济分析。
