EFFECT OF PATIENT CHARACTERISTICS ON HOSPITAL COSTS FOR CIRRHOSIS - IMPLICATIONS FOR THE DISEASE-RELATED GROUP (DRG) REIMBURSEMENT SYSTEM

The Prospective Payment System uses Diagnosis-Related Groups (DRG) as a reimbursement system, DRG 202 is a disease-related group including l iver cirrhosis as a whole, Patients referring to the inpatient unit co mplain of variable severity and complications of cirrhosis, possibly i mplying different expenditure of resources, Aim of the investigation w as to identify factors affecting cost variability in patients,vith cir rhosis, A total of 73 consecutive, DRG 202-assigned, cirrhotic patient s classified according to demographic and clinical variables were eval uated for length and costs of hospitalization calculated on a full-cos t basis, Mean length of hospitalization was 10.2+/-7 days, Mean cost o f hospitalization was Lit, 4.348.000+/-2.718.000, Medical, nursing, di agnostic, drug and general charges accounted for 13%, 29%, 37%, 5% and 16% of the cost, respectively, Child-Pugh score significantly correla ted with drug consumption (p<0.005), length (p<0.01) and costs (p<0.00 1) of hospitalization, but not with cost per day, Age, sex, admission status, referral reason, associated diseases and liver transplant susc eptibility did not correlate with duration and costs of hospitalizatio n. Disease severity significantly modifies costs of hospital admission in cirrhotic patients mostly on account of longer hospital stay, Surr ogate indexes of disease severity, derived from ISTAT/DRG records, can not identify patients consuming larger resources, In liver cirrhosis, the DRG system could be improved by introducing parameters, such as Ch ild-Pugh score, directly taking into account disease severity.