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Master Thesis

Étude de la balance coûts/recettes de la pratique de la dissection sous-muqueuse au CHU de Limoges

Abstract : Introduction. Endoscopic submucosal dissection (ESD) is a recent therapeutic endoscopy technique for the treatment of superficial cancerous lesions of the gastrointestinal tract of more than 2cm using new medical devices (DM) called electrosurgical knives. ESD has no specific code in the Joint Classification of Medical Procedures (CCAM) what constrains health institutions to code this intervention as conventional endoscopic mucosal resection (EMR); therefore, we thought it was necessary to conduct a study about the financial balance costs/incomes of the stays of patients hospitalized for ESD. Patients and Methods. An economic prospective study has been conducted based on all stays of patients hospitalized for ESD between January and December 2015. The financial balance of the stays was calculated by subtracting the full cost of the stay from the global DRG income. The full cost of the stay has been estimated by adding up fixed costs, fixed costs per day and some variables costs collected by micro costing. Results. 37 patients were enrolled. 30 stays showed a negative balance cost/incomes for the hospital. The hospital had a negative budget balance with an estimated deficit of 32,202.78 euros not covered by social security. Stays classified as DRG with a severity level upper to 1 and presence of cancer in a pathological report appeared to increase the probability to obtain a profitable financial balance for the hospital. The ESD procedure cost represents on average 53.7% of the full cost of the stay. Conclusion. The practice of ESD generates deficit for the hospital. However, the medical benefits for patients and the low cost of ESD practice compared to surgery should recommended its practice and justify its inclusion to the CCAM in order to get this procedure cost reimbursed to the hospital.
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Master Thesis
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Submitted on : Tuesday, September 27, 2016 - 1:44:23 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:06 PM
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  • HAL Id : dumas-01372552, version 1



Emmanuelle Pauliat. Étude de la balance coûts/recettes de la pratique de la dissection sous-muqueuse au CHU de Limoges. Sciences pharmaceutiques. 2016. ⟨dumas-01372552⟩



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