title: The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds.
abstract: BACKGROUND
  Crohn's disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable.
  
  
  METHODS
  IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants.
  
  
  RESULTS
  Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit.
  
  
  CONCLUSIONS
  DRGs challenge sophisticated IBD care.
authors.affiliation: Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Baumgart
authors.affiliation: Enterprise Controlling, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany.
authors.forename: Marie
authors.initials: M
authors.lastname: le Claire
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003953:Diagnosis-Related Groups; D006760:Hospitalization / Q000191:economics*; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics*; D008107:Liver Diseases / Q000191:economics*; D008875:Middle Aged