[Underfunding of surgical services in sarcoma treatment: a retrospective analysis of inpatient treatment costs at a university sarcoma center].

Abstract

Background and objective: Soft tissue sarcomas are rare heterogeneous tumors that require extensive treatment and should only be treated in specialized sarcoma centers. Surgical R0 resection with negative margins is one of the most important positive predictors of disease-specific survival. Comprehensive healthcare economic analyses of inpatient treatment costs are largely lacking but are essential to ensure sustainable and cost-effective care.

Methods: This retrospective single center study analyzed the inpatient costs of 112 sarcoma cases treated at this university tumor center between 2020 and 2022. The statistical analyses were performed to identify variables that influence case underfunding. Additionally, the revenue distribution was examined with respect to the frequency and extent of underfunding using the cost matrix of the Institute for the Remuneration System in Hospitals (InEK).

Results: A negative revenue balance was observed in 66.1% of cases, leading to a total deficit exceeding € 222,000. Significant predictors of underfunding included prolonged operation times, duration of intensive care stay and exceeding the average length of stay. The highest negative revenues were identified in the categories of "infrastructure costs", "medical technical services" and "operating room costs".

Conclusion: The results reveal significant underfunding of surgical sarcoma treatment in a specialized university sarcoma center. Adjustments to diagnosis-related groups (DRG)-based reimbursement are urgently needed to ensure the economic sustainability of care while safeguarding patient safety, academic training and making clinical decisions.