title: Economic evaluation of chronic lymphocytic leukemia from a hospital management perspective.
abstract: OBJECTIVE
  Treatment of chronic lymphocytic leukemia (CLL) is currently undergoing dramatic changes. We analyzed economic risks in hospitalized patients with CLL from a management perspective.
  
  
  METHODS
  One hundred and twelve patients with CLL hospitalized in 2013 and 2014 at the University Hospital of Cologne were analyzed. To assess profit margins (PMs) per case, diagnosis-related group (DRG) reimbursement data were merged with an internal cost accounting scheme depending on age, prognostic factors, and DRG key performance indicators.
  
  
  RESULTS
  In 112 patients, 284 cases coded by 19 different DRG with strongly fluctuating cost revenue ratios were found with an overall negative PM of €137 147. The DRG R61H was identified as the one most commonly coded (174 cases, 61.3%) with a deficit per case of €814. Subanalysis demonstrated that the payments were not cost covering due to excessive length of stay and staff costs. Significant differences in PM per case concerning age, length of stay and number of operation and procedure key (OPS) codes (P < 0.05) were found.
  
  
  CONCLUSIONS
  In our research-driven tertiary care hospital, inpatient treatment of patients with CLL is not cost covering. This analysis demonstrates the need for novel care/reimbursement structures in CLL. From a hospital management perspective, cost revenue controlling is crucial to avoid major economic risks.
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kron
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kutsch
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Kostenko
authors.affiliation: Department of Controlling, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Dohle
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.|Department of Controlling, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Glossmann
authors.affiliation: Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Heimann
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bahlo
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: von Bergwelt-Baildon
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wolf
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012051:Reimbursement Mechanisms
keywords: InEK matrix; chronic lymphocytic leukemia; cost accounting; cost controlling; diagnosis related groups reimbursement; hospital management