Cost analysis of hospital and home i.v. therapy in adults with cystic fibrosis. Results of a prospective controlled study

Background: The regular i.v.-therapy of adults with cystic fibrosis (CF) on an in-patient basis is regarded as expensive. Home treatment is supposed t o be cheaper. During a prospective controlled study to compare in-patient t reatment (SIT) with home i.v.-treatment (HIT) in regard to clinical, psycho social and economic parameters, delivered health services and costs in the German setting were evaluated in a comparatable manner. Patients and Methods: During the study period 4/95 to 9/9645 patients with altogether 56 hospital and 40 home i.v.-courses of approximately 14 days er e included in the study. Principal instruments to record the resource consu mption were documentation sheets kept by the medical staff and the patients . In addition, pharmacy accounts in HIT and patient records and hospital co ntrolling data in SIT were used. Results: The average costs of a course were 14,038 DM for HIT and 18,702 DM for SIT. Striking are the large differences in medication costs. Two main reasons could be identified for the cost difference: 1. the use of a mobile infusion system in HIT and 2. the much higher prices of pharmaceuticals in ambulatory care sector compared to the hospital sector, where extremely hi gh profits of the home care service firms or the pharmacy can be supposed. The social costs of HIT (when antibiotics are valued to opportunity costs) are estimated at less than 10,500 DM. From a societal perspective HIT is pr eferable, from the perspective of the statutory health insurance funds hosp ital therapy is preferable. Conclusions: 1. The widely accepted hypothesis that ambulatory care is chea per than hospital care is - at least in the German setting - not a-priori t rue. 2. In the treatment of CF patients incentive failures exist which indu ce unnecessary and avoidable hospital stays if the perspective of the statu tory sickness funds is dominant. 3. Changes in system conditions as e.g. th e permission of mail-order pharmacies might help to implement a more ration al allocation of resources.