title: [Does the hospital cost of care differ for inflammatory bowel disease patients with or without gastrointestinal infections? A case-control study].
abstract: OBJECTIVE
  Gastrointestinal Infections have been implicated as possible causes of exacerbation of inflammatory bowel disease (IBD) or risk factors for severe flares in general. The introduction of the G-DRG reimbursement system has greatly increased the pressure to provide cost effective treatment in German hospitals. Few studies have compared the costs of treating IBD patients with or without gastrointestinal infections and none of them have specifically considered the German reimbursement situation.
  
  
  METHODS
  We performed a single center case-control retrospective chart review from 2002 to 2011 of inpatients with IBD (Department of Internal Medicine IV, University Hospital Jena) with an exacerbation of their disease. The presence of gastrointestinal infections (Salmonella, Shigella, Campylobacter, Yersinia, adeno-, rota-, norovirus and Clostridium difficile) was assessed in all inpatients with Cohn's disease (CD) and ulcerative colitis (UC). IBD patients with gastrointestinal infections (n = 79) were matched for age to IBD patients who were negative for gastrointestinal pathogens (n = 158). Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e. g., endoscopy, microbiology, pathology) calculated according to an activity-based costing approach. All costs were discounted to 2012 values.
  
  
  RESULTS
  Gastrointestinal infections in IBD patients were not associated with an increase in mortality (0%); however, they were associated with 2.3-fold higher total hospital charges (6499.10 € vs. 2817.00 €; p = 0.001) and increased length of stay in hospital (14.5 vs. 9.4 days; p <  0.0001). Despite increased reimbursement by DRG for IBD patients with gastrointestinal infections compared to patients without infections (3833.90 € vs. 2553.50 €; p = 0.005), hospital care in these patients was substantially underfunded (deficit -2496.80 € vs. -433.10 €) because of increased length of stay with personnel costs, especially in UC.
  
  
  CONCLUSIONS
  Inpatient hospital costs differ significantly for IBD patients with and without gastrointestinal infections, especially in ulcerative colitis, when care was provided in a single university hospital.
authors.affiliation: Klinik für Innere Medizin IV; Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena.
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Klinik für Innere Medizin IV; Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena.
authors.forename: F
authors.initials: F
authors.lastname: Köhler
authors.affiliation: GB Rechnungswesen und Controlling, Universitätsklinikum Jena.
authors.forename: T
authors.initials: T
authors.lastname: Kräplin
authors.affiliation: Apotheke des Universitätsklinikums Jena.
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: Klinik für Innere Medizin A, Universitätsmedizin der Ernst-Moritz-Arndt-Universität, Greifswald.
authors.forename: M M
authors.initials: MM
authors.lastname: Lerch
authors.affiliation: Klinik für Innere Medizin IV; Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena.
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000191:economics* / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D014777:Virus Diseases / Q000191:economics* / Q000401:mortality / Q000628:therapy; D055815:Young Adult