OBJECTIVES:

Motor-neurone-diseases (MND) is a group of rare neurodegenerative disorders of the upper and lower motor neurons. They mainly progress rapidly, and usually lead to death within less than four years after diagnosis, mostly by respiratory failure.

An incidence of MND of 2,200 and a prevalence of 7,200 cases in Germany is suggested by registry data, also, that patients undergo basically minimum three hospitalizations. Firstly, for diagnosis-finding, secondly for feeding-tube implementation, driven by bulbar-paralysis, thirdly for initialization of ventilation. Here, inpatient data from German hospitals is analyzed for MND cases to prove discrimination of the three proposed hospitalizations and their accompanying DRG costs.

METHODS:

Data on inpatient care from the Institute for the Remuneration System in Hospitals (InEK) of 2020 was analyzed on MND case-billings. Software: Microsoft Excel®.

RESULTS:

2020 were 10,067 MND-hospitalizations coded, thereof 5,640 (56%) main and 4,427 (44%) secondary diagnosis. Total DRG spending was €41,671,500 (€4,140 per case), thereof €15,918,000 main (€2,822 per case) and €25,753,000 secondary diagnoses (€5,817 per case). This reflects €5.587 annual hospitalization-costs per patient, given the assumed prevalence.

59.7% of cases (35.5% of spending: €2,464 per case) were neurologic-DRGs, representing stays for diagnosis-finding and minor complications, including feeding-tube implantation. 938 feeding-tube-implantations had been found, suggesting the frequent implementation under hospital conditions. 15.3% of cases (7.1% spending: €1.927) are pulmonary-DRG without long term ventilation, representing late-stage disease. 14.0% of cases (45.5% spending: €13,491) are long term ventilation-DRG reflecting terminal stage of disease. In addition, the implantation of diaphragm-stimulators makes 0.9% of cases (4.5% spending: €20,005). 9.0% of cases (5.7% spending: €2,620) were other complications after diagnosis or unrelated diseases. 1.0% cases were rehabilitation measurements.

CONCLUSIONS:

The assumed three typical hospitalization-types could be detected in the billing-date. The late stage MND with pulmonary failure and long-term ventilation takes most of the hospitalization budget in Germany.