PMID- 31662284
OWN - NLM
STAT- MEDLINE
DCOM- 20200424
LR  - 20200424
IS  - 0398-7620 (Print)
IS  - 0398-7620 (Linking)
VI  - 67
IP  - 6
DP  - 2019 Nov
TI  - Economic challenges of using innovative medical devices in major public health 
      pathologies: Example of acute ischemic stroke management by mechanical 
      thrombectomy.
PG  - 361-368
LID - S0398-7620(19)30481-X [pii]
LID - 10.1016/j.respe.2019.08.003 [doi]
AB  - BACKGROUND: Activity-based Funding can induce financial imbalances for health 
      institutions if innovative medical devices (MD) used to perform acts are included 
      in Diagnosis Related Groups (DRG) tariff. To be reimbursed in addition to the DRG 
      tariff, innovative MD must have received a favorable evaluation by the French 
      National Authority for Health (Haute Autorite de Sante) and be registered on the 
      positive list. The aim of this study was to evaluate the expenses and incomes 
      generated by each scenario (before and after the reimbursement of MD), and the 
      financial reports. This study concerned the management of ischemic stroke by 
      mechanical thrombectomy devices, in high-volume French hospital. METHODS: All 
      patients who have had an acute ischemic stroke and admitted to the interventional 
      neuroradiology unit between January 2016 and December 2017 were included 
      retrospectively in this monocentric study. They were divided into four subgroups 
      based on the severity of the DRG. The cost study was carried out using the French 
      National Cost Study Methodology adjusted for the duration of the stays and by 
      micro-costing on MD. RESULTS: A total of 267 patients were included. Over the 
      study period, the average cost of the hospital stay was euro10,492+/-6364 for a refund 
      of euro9838+/-6749 per patient. The acts performed became profitable once the MD were 
      registered on the positive list (euro-1017+/-3551 vs. euro560+/-2671; P<0.05). Despite this 
      reimbursement, this activity remained in deficit for DRG lowest severity (level 
      1) patients (euro-492+/-1244). Specific MD used for mechanical thrombectomy 
      represented 37% of the total cost of stay. CONCLUSION: The time required to 
      evaluate MD reimbursement files is too long compared to their development. As a 
      result, practitioners are in difficulty to be able to carry out acts according to 
      the consensual practices of their learned societies, without causing any 
      financial deficit of their institutions.
CI  - Copyright (c) 2019 Elsevier Masson SAS. All rights reserved.
FAU - Nativel, F
AU  - Nativel F
AD  - Pharmacy department, university hospital, 85, rue Saint Jacques, 44093 Nantes, 
      France. Electronic address: fabien.nativel90@gmail.com.
FAU - Detraz, L
AU  - Detraz L
AD  - Neuroradiology department, university hospital, 44093 Nantes, France. Electronic 
      address: lili.detraz@gmail.com.
FAU - Mauduit, N
AU  - Mauduit N
AD  - Medical information department, university hospital, 44093 Nantes, France. 
      Electronic address: nicolas.mauduit@chu-nantes.fr.
FAU - Riche, V-P
AU  - Riche VP
AD  - Innovation cell, partnership and innovation department, directorate of medical 
      affairs and research, university hospital, 44093 Nantes, France. Electronic 
      address: valerypierre.riche@chu-nantes.fr.
FAU - Desal, H
AU  - Desal H
AD  - Neuroradiology department, university hospital, 44093 Nantes, France; Inserm 
      UMR1087, Institut du thorax, 44000 Nantes, France. Electronic address: 
      hubert.desal@chu-nantes.fr.
FAU - Grimandi, G
AU  - Grimandi G
AD  - Pharmacy department, university hospital, 85, rue Saint Jacques, 44093 Nantes, 
      France. Electronic address: gael.grimandi@univ-nantes.fr.
LA  - eng
PT  - Journal Article
DEP - 20191026
PL  - France
TA  - Rev Epidemiol Sante Publique
JT  - Revue d'epidemiologie et de sante publique
JID - 7608039
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Brain Ischemia/complications/economics/epidemiology/*therapy
MH  - Cost-Benefit Analysis
MH  - Equipment and Supplies/*economics
MH  - Female
MH  - France/epidemiology
MH  - Humans
MH  - Insurance, Health, Reimbursement/economics
MH  - Inventions/*economics/trends
MH  - Length of Stay/economics/statistics & numerical data
MH  - Male
MH  - *Mechanical Thrombolysis/economics/instrumentation/trends
MH  - Middle Aged
MH  - Public Health/*economics/statistics & numerical data/trends
MH  - Retrospective Studies
MH  - Stroke/complications/economics/epidemiology/*therapy
MH  - Thrombectomy/economics/instrumentation/trends
OTO - NOTNLM
OT  - Dispositifs medicaux
OT  - Health economics
OT  - Innovation
OT  - Mechanical thrombectomy
OT  - Medical devices
OT  - Micro-costing
OT  - Thrombectomie mecanique
OT  - Economie de la sante
EDAT- 2019/10/31 06:00
MHDA- 2020/04/25 06:00
CRDT- 2019/10/31 06:00
PHST- 2019/02/28 00:00 [received]
PHST- 2019/06/20 00:00 [revised]
PHST- 2019/08/28 00:00 [accepted]
PHST- 2019/10/31 06:00 [pubmed]
PHST- 2020/04/25 06:00 [medline]
PHST- 2019/10/31 06:00 [entrez]
AID - S0398-7620(19)30481-X [pii]
AID - 10.1016/j.respe.2019.08.003 [doi]
PST - ppublish
SO  - Rev Epidemiol Sante Publique. 2019 Nov;67(6):361-368. doi: 
      10.1016/j.respe.2019.08.003. Epub 2019 Oct 26.