[Conservative and operative treatment of working age patients with gonarthritis. Economic considerations].
BACKGROUND
The development of the overall achievements for hospital performance since the introduction in Germany of the diagnosis-related groups (DRG) system in 2003 is the subject of healthcare political discussion. The field of prosthetics is often at the center of considerations.


OBJECTIVE
After consideration of the development of achievements with international and regional earnings, the question was investigated how the average expenditure for patients with gonarthritis developed in a time period of 1 year before and after implantation of total knee prostheses.


METHODS
The study was based on individual patient data from the accounting data of the AOK (General Regional Healthcare Insurance) from the categories, inpatient care, panel physician treatment, pharmaceuticals and medicines as well as disability leave periods. The data include the average expenditure and disability times calculated by the AOK for individual patients 12 months before and 12 months after implantation of a total knee prosthesis. The methods were selected because the international classification of diseases (ICD) coding does not allow a differentiation in the degree of severity and, therefore, a comparison of patients who were only conservatively treated within the scope of panel physicians which would have led to problems in risk adjustment. Due to a lack of coding guidelines for treatment by panel physicians, the accuracy of the diagnosis is also limited in comparison to inpatient treatment data.


RESULTS
The expenditure and the average disability leave for gonarthritis patients were higher in the year following implantation of total knee prostheses than in the year prior to implantation.


CONCLUSIONS
No conclusions can be drawn from the provision of service data with respect to the quality of life of the patients. Investigations over a longer time period seem to be necessary.
AOK-Bundesverband, Rosenthaler Str. 31, 10178, Berlin, Deutschland, juergen.malzahn@bv.aok.de.
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Malzahn
D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data; D004467:Economics; D004651:Employment / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D018582:Sick Leave / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult