Case #520

Hypothermic intraperitoneal chemotherapy (HIPEC CRS) in colorectal cancer, pseudomyxoma peritonei and peritoneal mesothelioma

Added by Kristin Dahlen over 4 years ago. Updated over 4 years ago.

Status:RejectedStart date:2017-01-27
Priority:NormalSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Target version 2018
Initiator:Norway Target year:2018
MDC:MDC06 Owner / responsible:
Target Grouper:COMMON Old forum status:

Description

Problem
This is highly specialized surgery with curative goals (maximum cytoreductive surgery, CRS together with hot chemotherapy (HIPEC) in patiens with limited peritoneal carcinomatosis from colorectal cancer, pseudomyxsoma and mesothelioma.

CRS HIPEC is an extensive surgical treatment which often includes many sub-procedures with a very long operation time. The operation has an average knife to skin time of about 7.5 hours plus an additional 1.3 hours of anesthesia preparation in the operating theater (according to information from Oslo university hospital).

Analysis
The Norwegian Directorate of Health – 2017-01-23
The table show cases with procedurecode JAQ10 Intraoperativ hyperterm perfusjon av bukhulen med kjemoterapeutika in 2015 and per 2 tertial 2016. The most common diagnosis with 75% of the cases in 2015, are C18.- Ondartet svulst i tykktarm (neoplasma malignum coli) or C78.6 Metastase i retroperitonium og bukhinne. The properties for JAQ10 are, among others, 06S10 which leads to DRG 170/171 if no other procedures are included.

!HIPEC tab_1.png!

!HIPEC tab_2.png!

Figures from Oslo University hospital show an average cost of approx. 365 000 NOK.

DKDRG do have a group DRG0605 Operation for multiple kræftknuder i bughinde, m. opvarmet kemoterapi, pat. mindst 18 år for these of operations.

There are two different suggestions to solve the problem with these resource consuming cases. Either we can create a new DRG, or we can change the property for JAQ10 so the cases can be grouped to an existing DRG, for example DRGs 148/149 Større operasjoner på tynntarm/ tykktarm. As the number of cases are quite low, a change to an already existing DRG are preferred.

Suggestion
The Norwegian Directorate of Health – 2017-01-23
We want to bring this case up for discussion to receive any experiences from other countries on the issue. Cost data from Finland and Sweden will be appreciated, and make a better understanding of these cases. The discussion might be based on a suggestion that the cases with JAQ10 shall be grouped to DRG 148/ 149 Større operasjoner på tynntarm/ tykktarm instead of DRG 170/ 171 Operasjoner på fordøyelsesorganene ITAD.

Technical change

HIPEC tab_1.png (8.97 KB) Kristin Dahlen, 2017-01-27 17:03

#520.xlsx - #520 (42.5 KB) Kristiina Kahur, 2017-02-10 13:05

Swedish data #520.xlsx (10.6 KB) Veronika Stemme, 2017-03-08 11:44

History

#1 Updated by Kristin Dahlen over 4 years ago

  • Priority changed from Major to Normal

#2 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-Centre 2017-2-10

Very few cases in Finland - less than 8, only in one hospital, might be the case with coding.
In terms of LOS and cost, the cases with JAQ10 would not fit to DRGs 148/149. They do not fit to DRGs 170/171 either (see separate file # 520). Let's see what Swedish data show. Based on Finnish data, none of the proposals (new DRG or grouping to 170/171) doesn't solve the problem.

#3 Updated by Kristin Dahlen over 4 years ago

  • File deleted (HIPEC tab_2.png)

#4 Updated by Veronika Stemme over 4 years ago

Veronika Stemme, Sweden:
There are few cases with JAQ10 also in Sweden, 10 cases in 2015 with average cost 311 347 SEK and 10 cases in 2014 with average cost 306 113 SEK. In Sweden the cases are grouped to DRG F35/DRG 171 ‘Other digestive system o. r. procedures’. The JAQ10 cases are far more expensive than the average cost in this DRG but they would also be more expensive than the average cost in DRG F05/DRG 149 Major small & large bowel procedures. The medical description is better in DRG F35/DRG 171 than in DRG F05/DRG 149 since the procedure can be performed in diseases affecting other organs than the bowel. When it comes to reimbursement these cases are payed for as outer cases and that would be the same if they were moved to DRG F05/DRG 149. In summary, we do not want a change for the grouping of JAQ10. For Swedish cost data, please see attached file ‘Swedish data #520.xlsx’

#5 Updated by Martti Virtanen over 4 years ago

2017-03-08 Martti Virtanen
The number of cases is too low for a new group and the cases do not fit in any other group.
One option is to combine different rare and expensive cases to one group. Here one such could be intestinal transplants. What is the resource use of JFE00 and JFE96 (and what means the Swedish code DJ013)?

#6 Updated by Veronika Stemme over 4 years ago

Veronika Stemme,Sweden:
Very few cases with these procedure codes in Sweden. In KPP 2015 no cases with DJ013’Tunntarmstransplantation med multivisceral transplantation’, no cases with JFE00, 2 cases with JFE 96, quite disparate costs for these cases, 4 856 465 SEK and 124 350 SEK. In KPP 2014 there is 1 case with JFE00, cost for this case 3 004 535 SEK.

#7 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-9

The cost of the cases with JFE00 Transplantation of small intestine ranges between 96 935 and 305 486 EUR. Three cases in 2015. Three different DRGs: 120 Other circulatory system o. r. procedures, 149 Major small & large bowel procedures w/o cc and 432M Psychiatric rehabilitation.
All cases related to congenital functional disorders, one with main dx Q43.1 Hirschsprung's disease, two others Q43.2 Other congenital functional disorders of colon.
No use of code JFE96 in Finland in 2015.

#8 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Rejected

2017-03-13 Expert group
Expert group recommended no change in this case.

Also available in: Atom PDF