Case #521

Islet cell transplantation

Added by Kristin Dahlen over 3 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2017-01-27
Priority:NormalSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Target version 2018
Initiator:Norway Target year:2018
Case type:Major Owner / responsible:
MDC:MDC10 Old forum status:
Target Grouper:SWE

Description

National ID: HD-159
Initiated: 2017-01-23
Initiator: The Norwegian Directorate of Health

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Problem
Islet cell transplantations on patients with diabetes are grouped to DRG 292 Operasjoner ved sykdommer i HDG 10 ITAD m/bk or 293 Op ed sykdommer i HDG 10 ITAD u/bk. These islet cell transplantations do have a much higher cost than the average in these DRGs.

Analysis
The Norwegian Directorate of Health – 2017-01-23
By 2.tertial 2016 there are 3 cases with the procedurecode JLE20 allogen øycelletransplantasjon. None where reported with procedurecode JLE30 xenogen øyecelletransplantasjon.

!islet cell transplantation.jpg!

According to figures from Oslo university hospital an average cost for this treatment is about 336 000 NOK (33 cases from 2010 to 2015). Half of the costs are related to cell isolation prior to the operation.

Suggestion
The Norwegian Directorate of Health – 2017-01-23

As islet transplant is a beta cell supportive treatment like a pancreas transplantation, it would be appropriate that this procedure is grouped into more a more logical, excisting DRG. This can be either DRG 191A Transplantation of pancreas w/wo a kidney transplant, or DRG 191B Operations on pancreas/ liver. The procedurecodes JLE20 and JLE30 is already connected to DRG 191B for cases in MDC7. We suggest that the islet transplants group to this DRG also for cases with diabetes.

Islet cell transplantation.JPG (54.5 KB) Kristin Dahlen, 2017-01-27 17:14

TC #521 C705 .xlsx (21.6 KB) Ralph Dahlgren, 2017-04-12 14:37

Technical changes case #521.xlsx (46.7 KB) Martti Virtanen, 2017-04-21 10:54

Technical changes case #521-2.xlsx (36.5 KB) Martti Virtanen, 2017-12-14 18:07

History

#1 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-Centre 2017-2-10

No use of codes JLE20/JLE30 in Finland in 2015 and 2014.
In Finland, the cost of DRG 191B in 2014 was 22 454 EUR (# of cases 113), in 2015 22 422 EUR (# of cases 146).
Both proc codes have the property 07S01 Pancreas, liver or splancnic shunt procedure, and if the main diagnosis is from MDC 7, the case should group to DRG 191B or 192 (and also 192O).
What would be the technical change? Removing the property 10S08 Other endocrine, nutritional or metabolic system OR procedure from codes JLE20 and JLE30? In addition, removing the main diagnosis from MDC7 requirement from DRG 191B?
Although we do not have data to support the change due to the non-usages of codes JLE20/30, this change seems reasonable.

#2 Updated by Martti Virtanen over 3 years ago

2017-03-06 Martti Virtanen
There is a DRG for pancreas transplantation. What is the resource use of that DRG? Could Islet cell transplantion be combined with pancreas transplantation?

#3 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-3-6

According to Finnish data - DRG 191A Transplantation of pancreas with or without renal transplantation, cost 15 145 EUR, minimum 45 193 EUR, maximum 70 351 EUR, # of cases 14 (in 2015).

#4 Updated by Veronika Stemme over 3 years ago

Veronika Stemme, Sweden:
There are only few cases also in Sweden; in 2015 13 cases with JLE20 and no cases with JLE30. In 2015 the mean cost for JLE20 was 224859 SEK. The mean costs for the DRG:s where we find JLE20 were: 203807 SEK for DRG G05C (Pancreatic- liver and shunt operations, complicated), 100834 SEK for DRG L39C (Other endocrine, nutritional or metabolic disease o. r. procedure, complicated) and 87062 SEK for DRG L39E (Other endocrine, nutritional or metabolic disease o. r. procedure without cc). Thus the procedure JLE20 fits best in DRG G05C (NDMS-DRG 192C) and we support the Norwegian suggestion of change.

#5 Updated by Ralph Dahlgren about 3 years ago

2017-04-12. Sweden has done technical Changes to case #521. These will work for us at least.Can maybe be used by other?

#6 Updated by Martti Virtanen about 3 years ago

2017-03-13 Expert group
The proposal was accepted as proposed by Sweden.

#7 Updated by Martti Virtanen about 3 years ago

2017-04-20 Martti Virtanen
Since Sweden is using the CC group for DRG 192 that does not exist in the other versions of NordDRG, that model cannot be used.
The attached technical changes lis the related rules, dx's and interventions.
It would have been possible to use an existing procedure property, but to add a new makes the matter more clear.
The demand for diabetes as principal dx (Dgcat 10M01) is also acceptabe, although probably not really changing the assignmet.
The property 10S08 becomes obsolete since the new rules precede the rules using that proeprty. However, this will not affect the DRG assignment and allows usage of older logic versions and therefore I don't think it should be removed from these codes.

A question to Sweden: It is understandable that islet cell transfers are assigned to CC-leven group because of the nature of the intervention. But if there is a MCC-level complicating dx, shouldn't such case be assigned to MCC group?

#8 Updated by Ralph Dahlgren about 3 years ago

2017-04-27.
In the Swedish cost data there are very few cases concerning this and cost wise they fit best in DRG 05C.
The Swedish cost data are as below for the DRG 05C (NDMS-DRG 192C) and the other DRG on 05?:
DRG N mean
"G05A Pankreas-, lever- & shuntop M" 420 333 759
"G05C Pankreas-, lever- & shuntop K" 535 203 807
"G05E Pankreas-, lever- & shuntop U" 505 179 540
In 2015 the mean cost for 13 cases with JLE20 was 224 859 SEK, we did not have any cost data for JLE30 at all.
So out of that perspective we do not want these cases to be grouped to any other DRG.
We apreciate the question but we have thought it over again and are firm in how the cases should be grouped.

#9 Updated by Anja Fagervold over 2 years ago

We implement the solution proposed by Sweden. Thus all islet cell transplantations on patients with diabetes are grouped to DRG 191B in the Norwegian version.

#10 Updated by Martti Virtanen over 2 years ago

2017-12-14 Martti Virtanen
The change for Norway needes some adjustment. The solution is based on linkage of 191B in Sweden to G05C 'Pankreas-, lever- & shuntop K' and in Norway to 191B. This diminishes the need for extra rows.
See Technical changes new version for details.

#11 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Further active

2017-01-09
I retained this as further active to demonstrate the way to deal with the different versions with drglogic and drgnames.

#12 Updated by Martti Virtanen over 1 year ago

  • Status changed from Further active to Accepted

2018-03-13 Expert group
Expert group confirmed the changes.
The case is closed.

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