Comparison between Hospital Care Costs with Reimbursement on Diagnosis Related Group (DRG) Payment System and Outcomes of Therapeutic Plasma Exchange (TPE) at Naresuan University Hospital

Abstract

A retrospective study collected data on the costs of treatment and outcomes among patients receiving Therapeutic Plasma Exchange (TPE). Of 25 patients, 16 (64%) were females and mean age of patient was 53.2 + 16.3 years. A total of 120 cycles of TPE were performed. The mean length of stay was 20.2 + 16.9 days. The diagnosis revealed that 15 patients presented thrombotic thrombocytopenic purpura, 4 presented neuromyelitis optica, 2 had anti-glomerular basement membrane disease, 2 had Guillain-Barre Syndrome and 2 presented hyperthyroid. Mean TPE was 4.80 + 2.27 cycles. A total of 60% of replacement fluid constituted fresh frozen plasma. The most common complication was hypokalemia (24%). In all 20% of patients died. The main cause of death was due to infection, not from acute TPE complications. The mean total hospital care costs were 254,255.46 + 166,876.26 THB per patient while the mean adjusted relative weight was 17.08 + 11.33 per patient. Regarding a comparison between total hospital care costs with reimbursement belonging to the payment system of the hospital among 16 patients, the mean of deficit was 167,594.32 + 32,760.76 THB per patient. Total sum deficit for all 25 patients was 1,340,037.06 THB. The situation of tertiary care hospitals in the referral system of health insurance in Thailand using the DRG payment system faces deficits in advance care. The national health policy should increase funding to the DRG payment system to ensure that all patients have access to high cost medical services with equity.