Annual cost of hospitalization, inpatient rehabilitation and sick leave of anal cancer in Germany

Figures & data

Table 1.  Cost components of the analysis.

Cost component	Included in the analysis	Not included in the analysis
Direct costs by expenditure of social insurance bodies
Hospitalization^a	X
Expensive chemotherapy during hospitalization^b		X
Outpatient medical services covering physician visits, diagnostics, and treatments		X
Outpatient drugs including chemotherapy		X
Inpatient rehabilitation for employed patients	X
Inpatient rehabilitation for retired patients		X
Outpatient rehabilitation		X
Long-term care^c		X
Indirect costs based on the human capital approach
Sick leave	X
Premature retirement		X
Premature death		X

^aIncluding, inter alia, inexpensive chemotherapy covered and reimbursed by respective diagnosis-related groups.

^bNo expensive chemotherapy that is reimbursed via an additional fee could be linked to the diagnosis-related groups listed in Table 2 due to the nature of the database used (G-DRG Browser)12.

^cVariety of services provided in institutional or home care settings for those who are unable to perform activities of daily living independently for an expected period of at least half a year due to illness or disability.

Figure 1.  Distribution of hospitalizations for anal cancer in 2008 in Germany by age and gender.

Table 2.  G-DRGs reimbursed for hospital treatment of anal cancer in 2008 in Germany12.

Code	Description	Cost weight	Cost per G-DRG (€)	No. of cases per G-DRG	Major categories of treatment
					S	R	S&R	M
G01Z	Evisceration of the small pelvis	6.937	19,445	10	10
G07C	Appendectomy in the case of peritonitis with extremely severe or severe CC or minor surgery of small and large intestine without extremely severe CC, age >9 years	1.371	3843	1	1
G11B	Pyloromyotomy or anoproctoplastic and reconstruction of the anus and sphincter, age >9 years	0.749	2099	8	8
G15Z	Radiotherapy with major abdominal surgery	4.092	11,470	23			23
G16A	Complex rectal resection with surgery of liver metastases or complicating constellation	7.080	19,846	4	4
G16B	Complex rectal resection without surgery of liver metastases, without complicating constellation	3.757	10,531	243	243
G27A	Radiotherapy of illnesses and disorders of the digestive organs, LoS more than 1 day, more than eight sessions, with extremely severe CC	4.548	12,748	106		106
G27B	Radiotherapy of illnesses and disorders of the digestive organs, LoS more than 1 day, more than eight sessions, without extremely severe CC	2.467	6915	310		310
G29A	Other radiotherapy of illnesses and disorders of the digestive organs, LoS more than 1 day, with extremely severe CC	1.486	4165	112		112
G29B	Other radiotherapy of illnesses and disorders of the digestive organs, LoS more than 1 day, without extremely severe CC	0.972	2725	1176		1176
G60B	Malignant tumors of the digestive organs, LoS 1 day or without extremely severe CC	0.430	1205	25				25
Total				2018	266	1704	23	25

CC, complications or comorbidities; G-DRG, German diagnosis-related group; LoS, length of stay; M, medical; No., number; R, radiotherapy; S, surgery; S&R, surgery and radiotherapy.

Table 3.  Annual cost (€) of anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany (inconsistencies are due to rounding).

Cost category	Males	Females	Both genders
Direct costs
Hospitalization	11,434,076	18,065,635	29,499,711
Inpatient rehabilitation	443,731	882,332	1,326,063
Sub-total	11,877,807	18,947,967	30,825,774
Indirect costs
Sick leave	1,152,109	2,127,995	3,280,103
Total	13,029,916	21,075,962	34,105,877

InEK – Institut für das Entgeltsystem im Krankenhaus (Institute for the Hospital Remuneration System in Germany). GDRGBrowser_2008_Par21_100202.zip (G-DRG V2009 Daten 2008 gem. § 21 KHEntgG - G-DRG Browser) 2010. www.g-drg.de/cms/index.php/Datenveroeffentlichung_gem._21_KHEntgG. Accessed March 15, 2010

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