title: Comparison of actual hospital costs versus DRG revenues for in-patient treatment of febrile neutropenia during adjuvant anthracycline plus/minus taxane-based chemotherapy for primary breast cancer.
abstract: BACKGROUND
  In flat-rate reimbursement systems, the hospital's own costs should not exceed its revenues. In a cohort of primary breast cancer (pBC) patients, costs and reimbursement for febrile neutropenia (FN) were compared to verify cost coverage.
  
  
  METHODS
  A prospective, observational study in pBC patients receiving adjuvant anthracycline ± taxane-based chemotherapy calculated the costs per in-patient FN episode. The correlating revenues were retrospectively analyzed from diagnosis-related group (DRG) invoices. The actual costs of the therapies were compared to the individual DRG revenues, and the results are presented from the provider's perspective.
  
  
  RESULTS
  In 50 patients, n = 11 patients were treated for FN as in-patients. The hospital's overall treatment costs were € 18,288, on average (Ø) € 1663 per case (range € 1139-2344); the overall DRG revenues were € 23,593, Ø € 2145 per case (range € 1266-2660). In n = 8 cases, the DRGs were cost covering, and in n = 3 cases, a loss was observed, but overall resulting in a gain of Ø € 482 per case and thus being cost covering for the provider. Inadequate DRG coding (n = 4/11; 36.4%) resulted in a preventable loss of Ø € 1069/case.
  
  
  CONCLUSIONS
  The costs of FN treatment vary substantially and DRG reimbursements do not necessarily reflect the provider's costs. Surprisingly, the in-patient treatment of FN here is overall more than cost covering if adequately coded. The main reasons are asymmetrical costs for this FN low-risk pBC group. These results emphasize the importance of correct medical coding to avoid potential losses.
authors: Frauenklinik, OB/GYN, Klinikum rechts der Isar, Technische Universität München, Germany. volkerjacobs@hotmail.com
authors: Volker R
authors: VR
authors: Jacobs
authors: Stefanie C
authors: SC
authors: Mayer
authors: Bernadette J
authors: BJ
authors: Paessens
authors: Rudolf
authors: R
authors: Bernard
authors: Nadia
authors: N
authors: Harbeck
authors: Marion
authors: M
authors: Kiechle
authors: Angela
authors: A
authors: Ihbe-Heffinger
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics*; D001952:Bridged-Ring Compounds / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane