Weiland D E, Caruso D M, Kassir A, Bay R C, Malone J M
Maricopa Medical Center, Phoenix, AZ 85010, USA.
JSLS. 1997 Apr-Jun;1(2):175-80.
Many studies have attempted cost analysis of laparoscopic cholecystectomy as compared to open cholecystectomy. However, these analyses have included costs, charges, expenses, etc., and at times they have been used interchangeably. This paper demonstrates how DRG diagrams containing charges and length-of-stay, preoperative prediction of conversion rates, decision-tree construction and sensitivity analysis can be used to select the most cost-efficient operation for a given patient with cholecystitis.
A Delta DRG analysis for complicated cholecystectomy (DRG 195) showed the hospital to be an extreme outlier in both charges and length of stay. Record review indicated that 55% of the cases were converted laparoscopic cholecystectomies and the remainder were aged or younger patients with advanced disease. Chart and literature review determined the causes and the probability of conversion. Data were then placed into decision-tree and sensitivity analyses. The most cost-effective operation for a given probability of conversion was demonstrated.
Three preoperative findings and combinations of each predicted conversion rates and analysis showed that the charge of laparoscopic cholecystectomy must be held below the range of $5,361-$13,084 to make routine laparoscopic cholecystectomy cost-effective.
This method demonstrated that using Delta/DRG, decision-tree and sensitivity analysis offers physicians, hospitals and other health-care providers a method of evaluating the treatment of DRG categories to determine the most cost-effective management.
许多研究尝试对腹腔镜胆囊切除术与开腹胆囊切除术进行成本分析。然而，这些分析涵盖了成本、收费、费用等，有时它们被交替使用。本文展示了如何利用包含收费和住院时长的疾病诊断相关分组（DRG）图表、术前转化率预测、决策树构建以及敏感性分析，为特定胆囊炎患者选择最具成本效益的手术方式。
对复杂胆囊切除术（DRG 195）的Delta DRG分析显示，该医院在收费和住院时长方面都是极端异常值。病历审查表明，55%的病例是腹腔镜胆囊切除术中转开腹的，其余是患有晚期疾病的老年或年轻患者。通过图表和文献回顾确定了中转开腹的原因及概率。然后将数据进行决策树和敏感性分析。展示了针对给定中转概率最具成本效益的手术方式。
三项术前检查结果及其组合对转化率的预测和分析表明，要使常规腹腔镜胆囊切除术具有成本效益，腹腔镜胆囊切除术的收费必须保持在5361美元至13084美元的范围以下。
该方法表明，使用Delta/DRG、决策树和敏感性分析为医生、医院及其他医疗服务提供者提供了一种评估DRG分类治疗以确定最具成本效益管理方式的方法。
