INTRODUCTION: The objective of this study was to assess the impact of the Enhanced Recovery After Surgery (ERAS) programme implementation on treatment costs at a university-type centre, using the DRG scheme. MATERIALS AND METHODS: Retrospective analysis of patients' data in a group of 604 individuals enroled in the study. We evaluated three groups of patients according to the ERAS clinical protocol (CP): (1) CP oncogynaecology, (2) CP simple hysterectomy, (3) CP laparoscopy. The study aimed to evaluate the impact on the length of stay (LOS), savings in bed-days, and the reduction in direct treatment costs. Three parameters-antibiotic consumption, blood derivative consumption and laboratory test costs-were chosen to compare direct treatment costs. The statistical significance of the difference in the observed parameters was tested by a two-sample unpaired t test with unequal variances at the 0.05 significance level. RESULTS: We analysed data from 604 patients. In all three groups, the length of stay (LOS) was significantly reduced. The most significant reduction was observed in the CP oncogynaecology group, where the LOS was reduced from 11.1 days to 6.8 days (2022) and 7.6 days (2023) compared to 2019 (p < 0.05). Furthermore, there was a notable reduction in inpatient bed-days, which resulted in the capacity being made available to admit additional patients. A statistically significant reduction in direct costs was observed in the group of CP hysterectomy (antibiotic use) and in the CP laparoscopy (laboratory test costs). CONCLUSIONS: The implementation of the ERAS principles resulted in a number of significant positive economic impacts-reduction in the LOS and a corresponding increase in bed capacity for new patients. Additionally, direct treatment costs, including those related to antibiotic use or laboratory testing were reduced. The Czech Republic's acute healthcare system, like the majority of European healthcare systems, is financed by the DRG system. This flat-rate payment per patient encourages hospital management to seek cost-reduction strategies. The results of our study indicate that fast-track protocols represent a potential viable approach to reducing the cost of treatment while simultaneously meeting the recommendations of evidence-based medicine.
- MeSH
- Length of Stay statistics & numerical data economics MeSH
- Adult MeSH
- Gynecologic Surgical Procedures * economics MeSH
- Hysterectomy economics MeSH
- Diagnosis-Related Groups MeSH
- Laparoscopy economics MeSH
- Middle Aged MeSH
- Humans MeSH
- Health Care Costs * statistics & numerical data MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Enhanced Recovery After Surgery * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Advanced Therapy Medicinal Products (ATMPs) represent an innovative therapeutic approach with the potential to impact the treatment of rare diseases significantly. Although authorised centrally in the European Union, their market launch differs across Member States (MS). This study aimed to describe the ATMP market availability in MS and explore potential influencing factors, providing insights into specific barriers beyond pricing and reimbursement policies. METHODS: ATMP availability was defined as the product launch in each MS. Data was collected through open governmental sources, databases, and communication with national competent authorities. Spearman's correlation coefficients were calculated to examine the relationship between ATMP availability and their characteristics (time since granting marketing authorisation, target patient population size, and cost). RESULTS: We collected the availability data on 18 ATMPs from 23 EU MS. Market uptake varied significantly, with Germany (89%), France and Italy (61%) leading. Estonia and Latvia confirmed that no ATMP has been launched on their markets yet. Six ATMPs were available in more than one-third of the analysed MS. No significant correlation was observed between ATMP availability and analysed product characteristics except for time dependency for CAR T-cell therapies. CONCLUSION: Beyond pricing and reimbursement processes, the ATMP commercialisation in particular MS is influenced by the marketing authorisation holder's decision and capacity. ATMPs face product-specific challenges in achieving EU-wide availability, including complex manufacturing, distribution, and administration processes. To increase the accessibility of innovative ATMP-based treatments, implementing the cross-border access framework or individual ATMP production under the hospital exemption is essential, especially in underserved MS.
- MeSH
- Reimbursement Mechanisms * MeSH
- European Union MeSH
- Rare Diseases therapy MeSH
- Publication type
- Journal Article MeSH
Health care provider payment schemes consist of a complex set of arrangements used to influence provider behavior towards specific health policy objectives. The study aimed at: 1) providing a structured, comparative overview of current payment schemes within the public health system in selected Central and Eastern European (CEE) countries for different health care providers; 2) identifying and comparing major changes in payment schemes since 2010. Methods included: 1) data collection form development; 2) desk research; 3) national experts' consultations; 4) comparative analysis. The results indicate that the nine CEE countries (Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania) show numerous similarities in provider payment method mix and in the general direction of the recent changes conducted in this field. Output-based payment methods prevail across all countries and types of providers. Primary health care (PHC) providers are characterized by the most diverse payment method mix. PHC and hospital inpatient care have experienced the most frequent changes in their payment schemes within the last 13 years. These focused mostly on modifying existing payment methods (e.g. detailing payment categories), and applying additional methods to pay for specific services or performance (e.g. fee-for-service, bonus payments). The objectives of conducted change were often similar, thus, there is high potential for a shared, cross-country learning.
- MeSH
- Reimbursement Mechanisms * MeSH
- Humans MeSH
- Primary Health Care economics MeSH
- Health Policy MeSH
- Health Personnel MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic MeSH
- Croatia MeSH
- Estonia MeSH
- Europe MeSH
- Lithuania MeSH
- Latvia MeSH
- Hungary MeSH
- Poland MeSH
- Romania MeSH
- Europe, Eastern MeSH
- MeSH
- Reimbursement Mechanisms MeSH
- Health Services Accessibility * MeSH
- Pharmacies MeSH
- Humans MeSH
- Insurance, Health, Reimbursement MeSH
- Community Pharmacy Services economics organization & administration MeSH
- Insurance, Health MeSH
- Rural Health Services MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- MeSH
- Early Detection of Cancer MeSH
- Reimbursement Mechanisms MeSH
- Health Services Accessibility organization & administration MeSH
- Health Care Economics and Organizations MeSH
- Pharmaceutical Preparations economics supply & distribution MeSH
- Medical Informatics MeSH
- Drug Prescriptions economics MeSH
- Humans MeSH
- Prostatic Neoplasms diagnosis MeSH
- Hospitals, General organization & administration MeSH
- Osteoporosis diagnosis MeSH
- Public Health Administration * MeSH
- Health Information Management MeSH
- Mental Health Services organization & administration MeSH
- Patient Care Team MeSH
- Artificial Intelligence MeSH
- Health Information Systems MeSH
- Paramedics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- MeSH
- Early Detection of Cancer MeSH
- Health Services Accessibility MeSH
- Electronic Health Records MeSH
- Quality of Health Care MeSH
- Prescriptions standards MeSH
- Humans MeSH
- Health Care Costs MeSH
- Delivery of Health Care * organization & administration MeSH
- Reimbursement, Incentive MeSH
- Health Expenditures MeSH
- Insurance, Health organization & administration legislation & jurisprudence MeSH
- Health Workforce MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- Geographicals
- Czech Republic MeSH
- MeSH
- Health Services Accessibility MeSH
- Cardiac Surgical Procedures * economics MeSH
- Humans MeSH
- Fee-for-Service Plans MeSH
- Reimbursement, Incentive MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- News MeSH
