title: Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure.
abstract: OBJECTIVE
  Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact.
  
  
  METHODS
  This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs.
  
  
  RESULTS
  Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p < 0.05). HF in-hospital management generated most frequently deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of €24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was ∼ €16,300.
  
  
  CONCLUSIONS
  Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.
authors.affiliation: Cardiology Unit of the Heart and Vessels Department, AORN 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.forename: Cesare
authors.initials: C
authors.lastname: Baldi
authors.forename: Paola E
authors.initials: PE
authors.lastname: Di Blasi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Lorenzo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bellino
authors.forename: Feliciano
authors.initials: F
authors.lastname: Preziuso
authors.forename: Carlo
authors.initials: C
authors.lastname: Ranaudo
authors.forename: Rosario
authors.initials: R
authors.lastname: Sauro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosato
mesh_terms: D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008017:Life Expectancy; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011788:Quality of Life; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics* / Q000379:methods*
keywords: Cost; DRG; Heart failure; MitraClip; Mitral regurgitation