Determination of the cost of treatment of patients with complicated spinal injury at the thoracic and lumbar levels in a multidisciplinary hospital

Abstract

Introduction. The dramatic increase in the cost of treating patients with spinal cord injury is associated with the currently accepted active surgical tactics, as well as the use of new technologies, more expensive implants. Currently, a standardized method for calculating the costs of treating patients has not been developed, which may in the future lead to an incorrect assessment of the economic effectiveness of a particular treatment strategy.Aim. To assess the cost of diagnosis and treatment of patients with spinal injury of the thoracic and / or lumbar spine in a multidisciplinary emergency hospital.Materials and methods. The study was carried out in the Clinic of Emergency Neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department during 2018–2021. A working group was formed from the doctors of the neurosurgical department. Further, a model of the therapeutic and diagnostic process was compiled with a reflection of all its characteristics: 1) compilation of a mo dified operogram, 2) transformation of the operogram into a technological map, 3) comparison of the obtained characteristics of the process of diagnosis and treatment of patients with spinal injury with actual data, correction.Results. The operogram included 136 steps of the process from the moment of admission of a patient with spinal injury to the emergency department to the moment of discharge (surgery is the 77th step), and also reflected the interactions of 38 participants in the process and took into account the variety of possible methods and tactics of treatment, taking into account the average frequency of their use. Based on the developed process model, a technological map was prepared, which combined quantitative parameters for all key resource characteristics of the process.Conclusions. Hospital costs for the treatment of a patient with isolated complicated spinal injury at the level of the thoracic and lumbar spine in a specialized hospital amount to 600,652.41 rubles. Out of the total amount of expenses, surgical intervention costs amount to 48.7 %.