High cost factors for leukaemia and lymphoma patients: a new analysis of costs within these diagnosis related groups

Study objective-To determine high cost factors to help managers and clinici ans to analyse the reasons of adverse costs and provide indications for fin ancial negotiation. Design-To locate high cost or long stay patients, the analysis was designed on the basis of a mixture of Weibull distributions. In this new model, the proportion of high cost patients was expressed according to the multinomia l logistic regression, permitting the determination of high cost factors. Setting-The 1993 French reference database, constituted in the framework of the national study of DRG costs, conducted by the French Ministry of Healt h. The database of discharge abstracts recorded in 1993 in the Dijon public teaching hospital. Participants-The analyses were based on 1352 abstracts from the French refe rence database and 368 from the Dijon database concerning patients, aged 18 and over, suffering from leukaemia and lymphoma. Main results-High cost and long stay factors were the same: number of stays , death, transfer, acute leukaemia, neutropenia, septicaemia, high dose apl astic chemotherapy, central venous catheterisation, parenteral nutrition, p rotected or laminar airflow room, blood transfusion, and intravenous antibi otherapy. Conclusions-Taking into account high cost predictive factors, as shown in t he case of leukaemia and lymphoma patients, would help to reduce the advers e effects of a prospective payment system.