Comparative cost analysis of inpatient integrative medicine—Results of a pilot study

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Highlights

  • This study for the first time presents results of a comparative cost analysis of inpatient integrative medicine treatment including 1253 patients.

  • In-house comparisons with other departments found the department close to departments of Internal medicine.

  • Interhospital comparison revealed a comparable Casemix-Index and DRG-revenue.

  • In conclusion modern integrative in-patient treatment is mostly cost-equivalent to conventional treatment.

Abstract

Background

Costs of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs.

Methods

Data from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests.

Results

In total 1253 inpatients (81.4% female, 61.1 ± 14.4 years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly.

Conclusion

Modern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment.

Introduction

Integrative inpatient treatments have a long tradition in Germany with the first cold-water spa for inpatients being established in 1822 by Vinzenz Prießnitz in Gräfenberg/Freiwaldau in Silesia.1 Various other hospitals and health spas for naturopathic and homeopathic treatment were established soon thereafter.

The analysis of treatment costs for an integrative medical treatment compared to conventional medical treatments has been recognized as an important contribution to complementary medical research. A first “costing analysis” was conducted by the so called “Dresden Experiment” in 1938, where the length of stay and the respective costs were compared between a naturopathic medicine ward and a conventional one. According to Krauß.2 the duration of stay in the department for true naturopathy in Dresden in 1938 was 22 days, while in the conventional internal medicine department patients stayed 21 days on average. However average costs of medication per day were 58.0%–87.5% higher at the conventional site compared to the naturopathic site. Although this approach seemed reasonable and straightforward only a few studies in integrative medicine since then have focused on health economical aspects. Depending on the in- and exclusion criteria reviews found that between 6 and 338 studies conducted between 1984 and 2010 dealt with health economics. 3, 4, 5, 6, 7, 8, 9

Thus it is not surprising that White & Ernst in 2000 expressed the need for high quality health economic studies, which “could provide conclusive evidence of differences in costs and outcomes between other complementary therapies and orthodox medicine”.9 And ten years later Witt demanded more clinical and health services research “which includes economic data to provide realistic cost estimates for future healthcare”.10

Diagnose-related groups (DRGs) are frequently used for costing analyses in Germany, and other countries around the word.11, 12 Such data provide an evidence base for policy makers in funding authorities. However comparative costing analyses based on valid data have only marginally been used for integrative inpatient care.13, 14

The present comparative costing analysis of an inpatient integrative medicine treatment makes use of DRG data and for the first time analyses data from a department of integrative medicine by means of an inter- and intra-hospital comparison (Fig. 1).

Section snippets

Methods

Our costing analysis is based on the German DRG-system. DRGs are used in Germany since 2002 to categorize and reimburse hospitalization costs. DRGs are mandatory for all German hospitals except for mental health care institutions, and are defined by the patient's diagnoses, gender, age, treatment procedures, complications, comorbidities and further factors related to the hospitalization. Each DRG is assigned to a fixed cost weight, and the weight is calculated by the Institute for the Hospital

Results

In total 1253 inpatients were referred to the integrative medicine department in the entire year 2006 and included in the current analysis. The majority of patients were female (81.4%), and the mean age of patients was 61.1 ± 14.4 years with a range from 24 to 105 years. The vast majority of patients were treated for diseases of the musculoskeletal system (57.2% in total; and of those patients 44.6% were diagnosed with spinal conditions, 33.1% with soft-tissue diseases and 18.8% with

Discussion

The effectiveness of integrative medicine inpatient treatments has previously been demonstrated in clinical trials and cohort studies, mainly as part of the respective hospital’s quality assurance program.19, 20, 21, 22 Based on these findings, a recent study demonstrated the effectiveness of such a treatment on health-related quality of life in a large sample of more than 7.000 patients.23 However, cost analyses of such inpatient treatments, which are mainly implemented as national or regional

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  • C. Busch et al.

    Naturheilkunde unter DRG bedingungen

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