Misplon Sarah, Marneffe Wim, Missiaen Jana, Myny Dries, Decock Inge, Lervant Steve, Vaneygen Koen
Faculty of Business Economics, Hasselt University, Hasselt, Belgium.
AZ Groeninge, Kortrijk, Belgium.
Arch Public Health. 2024 Jun 24;82(1):95. doi: 10.1186/s13690-024-01317-1.
Oncological home hospitalization (HH) was implemented in a Belgian context to evaluate the feasibility of oncological HH. In a first HH model (HH1), implemented by three Belgian hospitals, two home nursing organizations and a grouping of independent nurses, the blood draw and monitoring prior to intravenous therapy was performed by a trained home nurse at the patient's home the day before the visit to the day hospital. In a second HH model (HH2), implemented in one hospital, the administration of two subcutaneous treatments (Azacitidine and Bortezomib) for myelodysplastic syndrome and multiple myeloma were provided at home instead of in the hospital. A previous study on this pilot showed that oncological HH is feasible and safe and improves the Quality of Life. The aim of this study is to investigate the cost and reimbursement of cancer treatment in these two HH models compared to the Standard of Care (SOC).
A bottom-up micro-costing study was conducted to compare the costs and revenues for the providers (hospitals and home care organizations) of the SOC and the HH models.
Costs associated to HH were higher than the SOC in the hospital. Comparing revenues with costs, the research revealed that the reimbursement from the National Health Insurance of HH for oncological patients is insufficient. In HH1, costs were higher than in the SOC (+ €50.4). There was a reduction in costs in the hospital by moving the blood draw to the home setting (-€23.9), but the costs in home care were higher (+ €74.3). The extra revenues in home care (+ €33.6) were insufficient to cover the costs. The cost difference between the SOC and HH2 (+ €9.5 for Azacetidine) was smaller than in HH1. But, there was almost no funding for subcutaneous administration in home care. If the product is administered in a day hospital, the hospital receives a revenue of €124 per administration, while in home care the funding is €5 per visit.
Costs of HH are higher and the reimbursement from Belgian NHI is insufficient to organize HH. As a result, HH for oncology patient is still limited in Belgium.
在比利时开展了肿瘤居家住院治疗（HH），以评估肿瘤居家住院治疗的可行性。在由三家比利时医院、两个居家护理组织和一群独立护士实施的首个HH模式（HH1）中，静脉治疗前的采血和监测由一名经过培训的居家护士在患者家中进行，时间为前往日间医院就诊的前一天。在一家医院实施的第二个HH模式（HH2）中，针对骨髓增生异常综合征和多发性骨髓瘤的两种皮下治疗（阿扎胞苷和硼替佐米）改为在家中而非医院进行。此前关于该试点的一项研究表明，肿瘤居家住院治疗是可行且安全的，并且改善了生活质量。本研究的目的是调查与标准治疗（SOC）相比，这两种HH模式下癌症治疗的成本和报销情况。
进行了一项自下而上的微观成本核算研究，以比较SOC和HH模式下提供者（医院和居家护理组织）的成本和收入。
医院中与HH相关的成本高于SOC。将收入与成本进行比较后，研究发现国家医疗保险对肿瘤患者HH的报销不足。在HH1中，成本高于SOC（高出50.4欧元）。通过将采血转移到居家环境，医院成本有所降低（减少23.9欧元），但居家护理成本更高（增加74.3欧元）。居家护理的额外收入（33.6欧元）不足以覆盖成本。SOC与HH2之间的成本差异（阿扎胞苷为9.5欧元）小于HH1。但是，居家护理中皮下给药几乎没有资金支持。如果在日间医院给药，医院每次给药可获得124欧元的收入，而在居家护理中，每次就诊的资金为5欧元。
HH的成本更高，比利时国家医疗保险的报销不足以支持HH的开展。因此，比利时肿瘤患者的HH仍然有限。
