Outpatient-based bone marrow transplantation for hematologic malignancies: Cost saving or cost shifting?
Outpatient-based bone marrow transplantation for hematologic malignancies: Cost saving or cost shifting?
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DOI：
10.1200/jco.1999.17.9.2811
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发表时间：
1999-09-01
影响因子：
45.3
通讯作者：
Bass, EB
中科院分区：
文献类型：
--
作者：
Rizzo, JD;Vogelsang, GB;Bass, EB
目的：为了确定从住院骨髓移植（BMT）到门诊骨髓移植（BMT）的转变是否降低了付款人的费用，而不增加患者的临床并发症或自付费用。患者和方法：这项非随机前瞻性队列研究比较了132例连续接受住院或门诊治疗的恶性血液病BMT患者的临床和经济结局。结果：132例BMT患者中有17例接受了门诊BMT治疗。与住院组相比，门诊组的平均住院天数明显减少（22 v47; P < .001），平均住院费用降低（每例患者减少61，059美元：P < .0001），但平均门诊费用较高（高出49，732美元; P < .0001），两组的总专业费用相似，平均总费用共同支付者仅少7%（12，652美元; P = 0.21），但门诊BMT的总费用比住院BMT低34（54，240美元; P = 0.056）在具有标准而非高治疗失败风险的患者亚组中。两组之间在交通、住宿、膳食、家庭护理、家庭援助、儿童护理、药物费用或未报销的医疗账单等自付费用方面没有显著差异。在报告的收入损失、非自愿失业或残疾月数方面，两组之间也没有显著差异。这两个群体畜群的主要并发症，包括死亡，严重的急性移植物抗宿主病，静脉闭塞性疾病的liver.Conclusion：增加使用门诊为基础的BMT应产生大量的费用节省支付者没有对患者的不良影响，对于那些没有高风险的治疗失败的患者。
Purpose: To determine whether a shift in care from an inpatient-based to an outpatient-based bone marrow transplantation (BMT) program decreased charges to payers without increasing clinical complications or out-of-pocket costs to patients.Patients and Methods: This nonrandomized prospective cohort study compared clinical and economic outcomes for 132 consecutive BMT patients with hematologic malignancies who received either inpatient- or outpatient-based BMT care.Results: Seventeen of 132 BMT patients underwent outpatient-based BMT. Compared with the inpatient-based group, the outpatient-based group had a markedly lower mean number of inpatient hospital days (22 v 47; P < .001) and decreased mean inpatient facility charges ($61,059 less per patient: P < .0001) but had higher mean outpatient facility charges ($49,732 higher; P < .0001), Total professional fees were similar for the groups, The mean total charge Co payers was only 7% less ($12,652; P = .21) for outpatient-based BMT than for inpatient-based BMT, but total charge was 34% less for outpatient compared with inpatient BMT ($54,240; P = 0.056) in a subset of patients who had a standard rather than high risk of treatment failure. There was no significant difference between groups in out-of-pocket costs for transportation, lodging, meals, home nursing, household assistance, child care, medication expenses, or unreimbursed medical bills. There also was no significant difference between groups in reported income lost, involuntary unemployment; or months of disability. The two groups herd similar rates of major complications, including death, significant acute graft-versus-host disease, and veno-occlusive disease of the liver.Conclusion: Increased use of outpatient-based BMT should produce substantial cost savings for payers without adverse effects on patients for those patients who do not have a high risk of treatment failure.