How well do DRGs for appendectomy explain variations in resource use? An analysis of patient-level data from 10 European countries

TY - JOUR

T1 - How well do DRGs for appendectomy explain variations in resource use?

T2 - An analysis of patient-level data from 10 European countries

AU - Mason, Anne

AU - Or, Zeynep

AU - Renaud, Thomas

AU - Street, Andrew David

AU - Thuilliez, Josselin

AU - Ward, Padraic

N1 - EuroDRG supplement

PY - 2012/7

Y1 - 2012/7

N2 - Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length-of-stay (three countries). The first model used only the Diagnosis Related Groups (DRGs) to which patients were coded; the second used a core set of general patient-level and appendectomy-specific variables; and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities, but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient’s age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy.

AB - Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length-of-stay (three countries). The first model used only the Diagnosis Related Groups (DRGs) to which patients were coded; the second used a core set of general patient-level and appendectomy-specific variables; and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities, but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient’s age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy.

KW - diagnosis-related groups; cost analyses; length of stay; appendectomy

UR - http://www.scopus.com/inward/record.url?scp=84864153403&partnerID=8YFLogxK

U2 - 10.1002/hec.2836

DO - 10.1002/hec.2836

M3 - Special issue

SN - 1057-9230

VL - 21

SP - 30

EP - 40

JO - Health Economics

JF - Health Economics

IS - Suppl. 2

ER -