Which factors render cost-covering lump-sum charging difficult for the treatment of patients with acute leukemias?

Background: Growing budget limitations and the planned charging subject to Diagnosis-Related Groups (DRG) points raise the question as to what costs a re incurred by the induction therapy and early consolidation treatment of p atients with acute myeloid leukemias (AML) and whether these can be compens ated in a cost-covering manner by a system based on DRG points. Patients an d Methods: For 100 patients recruited within the framework of the 'Kooperat ive AML-Studie 96' of the Suddeutsche Hamoblastosegruppe a process cost ana lysis was made between 1996 and 1999. All manpower and material costs incur red in the department itself and in the secondary services departments as w ell as the basic cost shares were recorded taking into due account the leng th of stay. The cost breakdown was effected based on a double induction the rapy and one early consolidation treatment. Results: It turns out that subs tantial differences exist between lower and upper limits of the length of s tay and costs: For all three therapy blocks for patients up to 60 years the cost spread varies between 63 and 204 kDM with a median of 105 kDM, and fo r older patients between 55.6 and 146.6 kDM with a median of 87.6 kDM. On a verage; the costs subject to length of stay were roughly 70%. Conclusions: As the costs per case are subject to a spread and, for this relatively smal l group of patients, are extremely high, the fixing of a case-related lump sum is problematic, the more so as age of patient, comorbidity, type of the rapy, ist outcome, and therapy-induced complications represent decisive inf luencing factors.