Effects of Enhanced Pacing Modalities on Healthcare Resources Utilization and Costs In

Effects of Enhanced Pacing Modalities on Healthcare Resources Utilization and Costs in Bradycardia Patients: an Analysis of the Randomized MINERVA Trial

Giuseppe Boriani1, MD, PhD; Antonis S. Manolis2, MD; Raymond Tukkie3, MD; Lluis Mont4, MD; Helmut Pürerfellner5, MD; Massimo Santini6, MD; Giuseppe Inama7, MD; Paolo Serra8, MD; Michele Gulizia9, MD; Igor Vasilyevich Samoilenko10, MD; Claudia Wolff11,PhD; Reece Holbrook12, MS; Federica Gavazza13, MS; Luigi Padeletti14, MD on behalf of the MINERVA Investigators

Supplementary Appendix:

Part I of the Appendix provides additional information about the cost calculations performed based on the health care utilisation collected in the MINERVA study.

Part II outlines the Investigators of the Minerva Study Group.

Appendix table of contents

1. Methods for Assessment of Health Care Utilization Data

a)US

b)UK

c)Italy

d)Spain

1. List of MINERVA Study Group Investigators

Section I.Methods for Assessment of Health Care Utilization Data

a) Health Care Utilization: US

Patient Selection from Premier Database:

DRGs used to identify patients with an IPG:

DRG Code / Description
37.70 / Initial insertion of lead [electrode], not otherwise specified
37.71 / Initial insertion of transvenous lead [electrode] into ventricle
37.72 / Initial insertion of transvenous leads [electrodes] into atrium and ventricle
37.73 / Initial insertion of transvenous lead [electrode] into atrium
37.80 / Insertion of permanent pacemaker, initial or replacement, type of device not specified
37.81 / Initial insertion of single-chamber device, not specified as rate responsive
37.82 / Initial insertion of single-chamber device, rate responsive
37.83 / Initial insertion of dual-chamber device
33206 / Insertion or replacement of permanent pacemaker with transvenous electrode (s); atrial
33207 / Insertion or replacement of permanent pacemaker with transvenous electrode (s); ventricular
33208 / Insertion or replacement of permanent pacemaker with transvenous electrode (s); atrial and ventricular

The 7.598 patients identified in the figure above had 2,031 inpatient visits with a primary diagnosis of AF in 2012. The next table shows the distribution of the DRGs from these visits. The distribution of costs by DRG for inpatient admissions is the weighted average of this table; this is how we calculated the average inpatient cost of $7,410.

DRGs for AF-related hospitalisations

DRG / DRG Description / Count / Median Costs / Mean Costs / STD Costs
216 / Crd vlv&oth mj crd/thr PX w crd cth wMCC / 1 / $86,806 / $86,806
217 / Crd vlv&oth mj crd/thr PX w crd cth wCC / 1 / $78,841 / $78,841
219 / Crd vlv&oth mj cd/thr PX w/o cd cth wMCC / 1 / $32,935 / $32,935
228 / Other cardiothoracic procedures w MCC / 1 / $31,719 / $31,719
230 / Othr cardiothoracic procedures w/oCC/MCC / 1 / $25,073 / $25,073
238 / Major cardiovasc procedures w/o MCC / 2 / $320,894 / $320,894 / $438,530
240 / Amp fr circ sys dsrdr exc up lmb&toe wCC / 1 / $61,181 / $61,181
246 / Prc crdvscPX w drgelt st wMCC or 4+vs/st / 2 / $18,234 / $18,234 / $3,756
247 / Perc crdvsc PX w drug-elut stent w/o MCC / 3 / $12,571 / $12,216 / $2,695
248 / Prc crdvscPX w nndrgelt st wMCC /4+vs/st / 1 / $14,070 / $14,070
250 / Perc crdvsc PX w/o cornry art stent wMCC / 28 / $14,006 / $16,890 / $8,276
251 / Perc crdvsc PX w/o crnry art stnt w/oMCC / 128 / $15,853 / $16,732 / $9,820
252 / Other vascular procedures w MCC / 2 / $15,567 / $15,567 / $5,820
253 / Other vascular procedures w CC / 1 / $5,842 / $5,842
264 / Other circulatory system O.R. procedures / 1 / $42,423 / $42,423
280 / Acute MI, discharged alive w MCC / 7 / $18,576 / $19,276 / $9,636
281 / Acute MI, discharged alive w CC / 8 / $8,030 / $9,676 / $6,217
282 / Acute MI, discharged alive w/o CC/MCC / 4 / $5,569 / $6,270 / $4,452
283 / Acute myocardial infarction, expird wMCC / 1 / $9,617 / $9,617
286 / Circ disorders exc AMI, w card cath wMCC / 20 / $12,963 / $19,030 / $21,312
287 / Circ disordrs exc AMI, w crd cath w/oMCC / 48 / $8,022 / $9,357 / $5,346
308 / Card arrhythmia & conduct disorders wMCC / 371 / $7,072 / $8,529 / $5,723
309 / Card arrhythmia & conduct disorders wCC / 582 / $4,840 / $6,187 / $5,077
310 / Card arrhyth&conduct disorders w/oCC/MCC / 810 / $3,448 / $4,136 / $2,855
981 / Ext OR PX unrelated to principal DX wMCC / 1 / $36,840 / $36,840
982 / Ext OR PX unrelated to principal DX w CC / 2 / $12,844 / $12,844 / $1,588
983 / Ext OR PX unrelate to prin DX w/o CC/MCC / 2 / $27,680 / $27,680 / $9,915
989 / Non-ext OR PX unrelatd prin DX w/oCC/MCC / 1 / $868 / $868

ED visits:

Since the Premiere database has a limitation in that ambulatory payment classifications are not available, the cost of $1,333 for these patients is a simple average of the cost of all ED visits with a primary diagnosis of AF found for the patients with an IPG.

Outpatient visits:

The costs of an unscheduled out-patient visit were not available in the Premier database and had to be derived from a different source. These clinic visit costs were estimated based on the recommended procedures for AF patients in the American AF Guidelines and the associated Medicare reimbursement. The Medicare reimbursement was then converted to hospital costs using the aggregate payment-to-cost ratio established by the American Hospital Association Annual Survey(23). The cost calculations are shown in the table below.

Table . Clinical Evaluation in Patients with AF-related outpatient visits / Procedure code / Medicare Tariff 2014 / Payment/Cost Ratio / Calculated Hospital Costs
1. History and physical examination, to define / 99214 / $105.67 / 92.40% / $114.36
Presence and nature of symptoms associated with AF
Clinical type of AF (first episode, paroxysmal, persistent, or permanent)
Onset of the first symptomatic attack or date of discovery of AF
Frequency, duration, precipitating factors, and modes of termination of AF
Response to any pharmacological agents that have been administered
Presence of any underlying heart disease or other reversible conditions (eg, hyperthyroidism or alcohol consumption)
2. Electrocardiogram, to identify / 93000 / $16.50 / 92.40% / $17.86
Rhythm (verify AF)
LV hypertrophy
P-wave duration and morphology or fibrillatory waves
Preexcitation
Bundle-branch block
Prior MI
Other atrial arrhythmias
To measure and follow the R-R, QRS, and QT intervals in conjunction with antiarrhythmic drug therapy
3. Transthoracic echocardiogram, to identify / 93308
93308-26 / $121.12 / 92.40% / $131.08
Valvular heart disease
LA and RA size
LV size and function
Peak RV pressure (pulmonary hypertension)
LV hypertrophy
LA thrombus (low sensitivity)
Pericardial disease
4. Blood tests of thyroid, renal, and hepatic function / 80076 / $15.06 / 92.40% / $16.30
For a first episode of AF, when the ventricular rate is difficult to control / 80069 / $16.01 / 92.40% / $17.33
84443 / $30.98 / 92.40% / $33.53
Total Costs / $330.45

b)Health Care Utilization: UK

HRG AF-related hospitalisations
Total Unit cost
EB07H / Arrhythmia or Conduction Disorders, with CC / 1357.493025
EB07I / Arrhythmia or Conduction Disorders, without CC / 818.4176596
EA29Z / Percutaneous Complex Ablation, including for Atrial Fibrillation or Ventricular Tachycardia / 4,414
Emergency Visits
Accident and Emergency Services: Leading to Admitted
Currency Code / Currency Description / Attendances / National Average Unit Cost
VB01Z / Emergency Medicine, Any Investigation with Category 5 Treatment / 16,112 / £359
VB02Z / Emergency Medicine, Category 3 Investigation with Category 4 Treatment / 56,275 / £319
VB03Z / Emergency Medicine, Category 3 Investigation with Category 1-3 Treatment / 223,632 / £245
VB04Z / Emergency Medicine, Category 2 Investigation with Category 4 Treatment / 428,472 / £210
VB05Z / Emergency Medicine, Category 2 Investigation with Category 3 Treatment / 176,354 / £183
VB06Z / Emergency Medicine, Category 1 Investigation with Category 3-4 Treatment / 83,126 / £137
VB07Z / Emergency Medicine, Category 2 Investigation with Category 2 Treatment / 489,473 / £162
VB08Z / Emergency Medicine, Category 2 Investigation with Category 1 Treatment / 1,455,243 / £155
VB09Z / Emergency Medicine, Category 1 Investigation with Category 1-2 Treatment / 657,025 / £114
VB10Z / Emergency Medicine, Dental Care / 1,169 / £152
VB11Z / Emergency Medicine, No Investigation with No Significant Treatment / 453,879 / £94
Weighted Average is 155 GBP
Accident and Emergency Services: Not Leading to Admitted
Currency Code / Currency Description / Attendances / National Average Unit Cost
VB01Z / Emergency Medicine, Any Investigation with Category 5 Treatment / 11,890 / £264
VB02Z / Emergency Medicine, Category 3 Investigation with Category 4 Treatment / 24,499 / £257
VB03Z / Emergency Medicine, Category 3 Investigation with Category 1-3 Treatment / 169,703 / £220
VB04Z / Emergency Medicine, Category 2 Investigation with Category 4 Treatment / 168,700 / £191
VB05Z / Emergency Medicine, Category 2 Investigation with Category 3 Treatment / 181,758 / £164
VB06Z / Emergency Medicine, Category 1 Investigation with Category 3-4 Treatment / 367,364 / £114
VB07Z / Emergency Medicine, Category 2 Investigation with Category 2 Treatment / 1,047,032 / £143
VB08Z / Emergency Medicine, Category 2 Investigation with Category 1 Treatment / 2,756,855 / £131
VB09Z / Emergency Medicine, Category 1 Investigation with Category 1-2 Treatment / 2,981,590 / £91
VB10Z / Emergency Medicine, Dental Care / 1,145 / £68
VB11Z / Emergency Medicine, No Investigation with No Significant Treatment / 2,695,226 / £71
Weighted Average is 119 GBP
Comment: We use category 1-3 and investigation categories 1-3, assuming that AF-related emergency visits are not the most severe ones. Codes marked in greyare included.
Outpatient Visits
Consultant Led: Follow up Attendance Multiprofessional Non-Admitted Face to Face / National Average Unit Cost
320 / Cardiology / £201
Source: / National Schedule of Reference Costs Year : 2011-12

c) Health Care Utilization: Italy

REGIONS / Regional Decrees about DRG tariffs
ABRUZZO / DCA n. 13 del 20.02.2013 “ Approvazione, del tariffario regionale per la remunerazione delle prestazioni di assistenza ospedaliera D.M 18.10.2012.”
BASILICATA / DCA n. 463 del 30.04.2013 “ Adozione, ai sensi del Decreto 18/10/2012 pubblicato sulla G:U. n.23 del 28/1/2013, delle nuove tariffe per la remunerazione delle prestazioni di ricovero.”
BOLZANO / DGR 1039 Bollettino Ufficiale n. 28/I-II del 12/07/2011 – Aggiornamento del tariffario provinciale delle prestazioni di assistenza ospedaliera in Regime di ricovero per acuti ordinario e diurno a aprtire dal 1 agosto 2011
CALABRIA / DCA 11.02.2013. n. 19 “Decreto Ministero della Salute del 18.10.2012 recante Remunerazione delle prestazioni di assistenza ospedaliera per acuti, assistenza ospedaliera di riabilitazione e di lungodegenza post acuzie e di assistenza specialistica ambulatoriale”
CAMPANIA / DCA n. 32 del 27.03.2013 “Decreto Ministeriale 18.10.2012. in materia di criteri e tariffe dell’assistenza ospedaliera e dell’assistenza specialistica ambulatoriale – determinazioni – Rif. Punto r) delibera del Consiglio dei Ministri del 24 aprile 2010.”
EMILIA ROMAGNA / DGR n. 525/2013 “ Determinazione delle tariffe per prestazioni di assistenza ospedaliera in strutture pubbliche e private accreditate della Regione Emilia Romagna applicabili a decorrere dall’1/1/2013.”
FRIULI VENEZIA GIULIA / DGR 1535 2009/R - Determinazione delle tariffe regionali per il
pagamento delle prestazioni di ricovero ospedaliero
per acuti in vigore dal 1° gennaio 2009.
LAZIO / DCA n. 310 “Approvazione del tariffario regionale per la remunerazione delle prestazioni di assistenza ospedaliera" applicabili a decorrere dall’4/07/2013.”
LIGURIA / DGR n. 1970/2009
Aggiornamento del tariffario per la remunerazione delle prestazioni di assistenza ospedaliera. Introduzione in
Regione Liguria del nuovo sistema di classificazione ricoveri ospedalieri ICD-9-CM 2007 versione 24 Grouper.
LOMBARDIA / Deliberazione X / 1185 del 20/12/2013 - DETERMINAZIONI IN ORDINE ALLA GESTIONE DEL SERVIZIO SOCIO SANITARIO REGIONALE PER
MARCHE / DRG. n. 1648 del 2011- Aggiornamento delle Tariffe dei ricoveri ospedalieri per Acuti: nuova valorizzazione dei DGR in regime di ricovero ordinario e di Day-Hospital
MOLISE / DCA n.19 del 27.06.2013 "Nomenclatore tariffario Regionale delle Prestazioni di Ricovero ospedaliero - applicabile a decorrere dalle 12-02-2013".
PIEMONTE / DGR n. 14-6039 “ Determinazione delle tariffe per prestazioni di ricovero dagli istituti pubblici, dai Presidi classidicati, dagli IRCCS e dalle case di cura accreditate applicabili a decorrere dall’1/07/2013.”
PUGLIA / DGR 13.05.2013, n.951 “OGGETTO: D.M. 18 OTTOBRE 2012- Remunerazione
delle Prestazioni di assistenza Ospedaliera, di
riabilitazione, di lungodegenza e di assistenza specialistica ambulatoriale erogabili dal SSR Approvazione
del nuovo tariffario regionale .”
SARDEGNA / DGR N. 60/26 DEL5.11.2008
Aggiornamento del tariffario per la remunerazione delle prestazioni di assistenza
ospedaliera.
DGR n. 17-3/2009
Recepimento del D.M. 18.12.2008 “Aggiornamento dei sistemi di classificazione adottati per la codifica delle
informazioni cliniche contenute nella scheda di dimissione ospedaliera e per la remunerazione delle prestazioni
ospedaliere” e definizione delle tariffe di riferimento provvisorie per i ROD di nuova introduzione
SICILIA / DCA 14.05.2013, n.923 “Recepimento decreto Ministero della salute di concerto con il Ministero dell’Economia e Finanze del 18 ottobre 2012-allegati 1 e 2- tariffe per le prestazioni di assistenza ospedaliera”
TOSCANA / DGR n. 1184 9 dicembre 2008 - Determinazione delle tariffe regionali per il pagamento delle prestazioni di ricovero ospedaliero per acuti in vigore dal 1° gennaio 2009.
TRENTO / DGR n. 936 del 11 maggio 2012, Determinazione delle tariffe per le prestazioni di assistenza ospedaliera con decorrenza 1° gennaio 2012
UMBRIA / D.G.R. n.886 del 27.07.2013 Linee guida per la stipula degli accordi contrattuali tra le strutture erogatrici pubbliche e tra le Aziende U.S.L. e le strutture private che intrattengono rapporti con il Servizio Sanitario Regionale per l'anno 2013 - Approvazione del tariffario regionale.
VALLE D'AOSTA / DGR 15.03.2013, n. 427 “ Approvazione, a decorrere dal 1° marzo, del tariffario regionale per le prestazioni di ricovero ospedaliero-versione 24 del grouper. Revoca delle dgr n. 1401 del 22.05.2009 e n. 68 del 25.01.2013.”
VENETO / DGR 10.04.2013, n. 442
Recepimento del DM 18 ottobre 2012 di “Remunerazione prestazioni di assistenza ospedaliera per acuti,
assistenza ospedaliera di riabilitazione e di lungodegenza post acuzie e di assistenza specialistica
ambulatoriale” del Ministro della Salute di concerto con il Ministro dell’Economia e delle Finanze e
aggiornamento del Nomenclatore Tariffario Regionale dell’assistenza specialistica ambulatoriale di cui alla DGR
n. 859 del 21.6.2011.

In many regions, hospitals are classified in several categories according to one or more of the following main criteria:

-private or public hospitals

-how many patients they care each year

-the number of Departments they have

-if they are Research Institute

Here below the regional categories for each Region:

REGIONS / CATEGORIES
ABRUZZO / only one category
BASILICATA / only one category
BOLZANO / category A, B and INDIRETTA
CALABRIA / only one category
CAMPANIA / categories from 1 to 7
EMILIA ROMAGNA / categories A1, A2, B and C
FRIULI VENEZIA GIULIA / categories A and B
LAZIO / categories A,B,C and D
LIGURIA / categories A and B
LOMBARDIA / categories DEA (it states for and Emergency Department with surgical rooms 24h/24h), PS (it states for the usual Emergency Department) and without PS or DEA
MARCHE / categories A, B and C
MOLISE / categories A and B
PIEMONTE / categories PRIVATE A, B and C and only one category for public hospital
PUGLIA / categories PRIVATE A, B and C and only one category for public hospital
SARDEGNA / only one category
SICILIA / categories A, B and C
TOSCANA / categories A, B and AREA VASTA
TRENTO / categories A, B, C
UMBRIA / categories A,B and C
VALLE D'AOSTA / categories A and B
VENETO / only one category

Here below the tariffs for each Region according to the main DRGs needed for the computations:

REGIONS / DRG 518
Ablation
(w/o major CV diagnosis) / DRG 518 Day Hospital
Ablation (w/o major CV diagnosis) / DRG 555
Ablation (with major CV diagnosis)
ABRUZZO / € 3.868,89 / € 2.525,23 / € 6.061,14
BASILICATA / € 3.962,00 / € 2.586,00 / €6.207,00
BOLZANO A / € 5.268,75 / € 5.145,10 / € 11.042,34
BOLZANO B / € 5.887,39 / € 1.971,24 / € 8.853,90
BOLZANO INDIRETTA / € 4.957,99 / € 1.659,89 / € 7.559,04
CALABRIA / € 3.962,00 / € 2.586,00 / € 6.207,00
CAMPANIA 1 / € 3.962,00 / € 2.586,00 / € 6.207,00
CAMPANIA 2 / € 3.763,90 / € 2.456,70 / € 5.896,65
CAMPANIA 3 / € 3.565,80 / € 2.327,40 / € 5.586,30
CAMPANIA 4 / € 3.565,80 / € 2.327,40 / € 5.586,30
CAMPANIA 5 / € 3.090,36 / € 2.017,08 / € 4.841,46
CAMPANIA 6 / € 2.694,16 / € 1.758,48 / € 4.220,76
CAMPANIA 7 / € 3.565,80 / € 2.327,40 / € 5.586,30
EMILIA ROMAGNA A1 / € 4.081,36 / € 2.663,96 / € 6.393,09
EMILIA ROMAGNA A2 / € 3.962,49 / € 2.586,37 / € 6.206,89
EMILIA ROMAGNA B / € 3.764,28 / € 2.456,99 / € 5.896,46
EMILIA ROMAGNA C / € 3.566,24 / € 2.327,73 / € 5.586,20
FRIULI VENEZIA GIULIA A / € 9.340,00 / € 731,00 / € 11.723,00
FRIULI VENEZIA GIULIA B / € 5.975,00 / € 574,00 / € 9.230,00
LAZIO A,B,C / € 3.962,00 / € 2.586,00 / € 6.207,00
LAZIO D / € 3.763,90 / € 2.456,70 / € 5.896,65
LIGURIA A / € 5.207,00 / € 4.686,00 / € 6.548,49
LIGURIA B / € 5.727,70 / € 5.154,60 / € 7.203,34
LOMBARDIA DEA / € 4.592,04 / € 4.142,14 / € 5.564,47
LOMBARDIA PS / € 4.592,04 / € 4.142,14 / € 5.402,40
LOMBARDIA / € 4.592,04 / € 4.142,14 / € 5.240,33
MARCHE A / € 6.711,08 / € 5.368,86 / € 10.906,94
MARCHE B / € 6.161,83 / €4.921,46 / € 9.998,03
MARCHE C / € 5.592,57 / € 4.474,05 / € 9.089,12
MOLISE A / € 3.962,00 / € 2.586,00 / € 6.207,00
MOLISE B / € 3.367,70 / € 2.198,10 / € 5.275,95
PIEMONTE / € 3.962,00 / € 2.586,00 / € 6.207,00
PIEMONTE PRIVATE A / € 3.962,00 / € 2.586,00 / € 6.207,00
PIEMONTE PRIVATE B / € 3.645,04 / € 2.379,12 / € 5.710,44
PIEMONTE PRIVATE C / € 3.367,70 / € 2.198,10 / € 5.275,95
PUGLIA / € 3.962,00 / € 2.586,00 / € 6.207,00
PUGLIA A - private / € 3.882,76 / € 2.534,28 / € 6.082,86
PUGLIA B - private / € 3.645,04 / € 2.379,12 / € 5.710,44
PUGLIA C - private / € 3.367,70 / € 2.198,10 / € 5.275,95
SARDEGNA / € 5.369,52 / € 4.027,14 / € 9.299,98
SICILIA A / € 3.962,00 / € 2.586,00 / € 6.207,00
SICILIA B / € 3.902,57 / € 2.547,21 / € 6.113,90
SICILIA C / € 3.744,09 / € 2.443,77 / € 5.865,62
TOSCANA A / € 5.425,00 / € 4.069,00 / € 9.013,00
TOSCANA B / € 4.774,00 / € 3.580,00 / € 7.931,00
TOSCANA AREA VASTA / € 5.425,00 / € 4.069,00 / € 9.283,00
TRENTO A / € 6.886,34 / € 6.874,76 / € 12.101,36
TRENTO B / € 6.076,18 / € 6.342,37 / € 11.077,40
TRENTO C / € 6.076,18 / € 4.860,94 / € 9.774,18
UMBRIA A / € 3.962,00 / € 2.586,00 / € 6.207,00
UMBRIA B / € 3.962,00 / € 2.586,00 / € 6.207,00
UMBRIA C / € 3.962,00 / € 2.586,00 / € 6.207,00
VALLE D'AOSTA A / € 3.962,00 / € 2.586,00 / € 6.207,00
VALLE D'AOSTA B / € 3.684,66 / € 2.404,98 / € 5.772,51
VENETO / € 5.592,57 / € 5.592,57 / € 9.448,80
Mean value / € 4.501,75 / € 3.084,74 / € 7.014,96
REGIONS / DRG 138 (arrhtymias w/o cc) / DRG 138 Day-H
(arrhtymias w/o cc) / DRG 139 (arrhytmias with cc) / DRG 139 (arrhytmias with cc)
ABRUZZO / € 2.319,19 / € 223,62 / € 951,11 / € 178,70
BASILICATA / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
BOLZANO A / € 3.777,12 / € 500,60 / € 2.391,39 / € 449,60
BOLZANO B / € 3.070,23 / € 305,27 / € 1.799,65 / € 231,66
BOLZANO INDIRETTA / € 2.585,38 / € 257,20 / € 1.515,28 / € 195,22
CALABRIA / €2.375,00 / € 229,00 / € 974,00 / € 183,00
CAMPANIA 1 / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
CAMPANIA 2 / € 2.256,25 / € 217,55 / € 925,30 / € 173,85
CAMPANIA 3 / € 2.137,50 / € 206,10 / € 876,60 / € 164,70
CAMPANIA 4 / € 2.137,50 / € 206,10 / € 876,60 / € 164,70
CAMPANIA 5 / € 1.852,50 / € 178,62 / € 759,72 / € 142,74
CAMPANIA 6 / € 1.615,00 / € 155,72 / € 662,32 / € 124,44
CAMPANIA 7 / € 2.137,50 / € 206,10 / € 876,60 / € 164,70
EMILIA ROMAGNA A1 / € 2.446,46 / € 124,47 / € 1.003,00 / € 124,47
EMILIA ROMAGNA A2 / €2.375,21 / € 124,47 / € 973,79 / € 124,47
EMILIA ROMAGNA B / € 2.256,44 / € 124,47 / € 925,02 / € 124,47
EMILIA ROMAGNA C / € 2.256,44 / € 124,47 / € 925,02 / € 124,47
FRIULI VENEZIA GIULIA A / € 4.496,00 / € 448,00 / € 2.636,00 / € 338,00
FRIULI VENEZIA GIULIA B / € 3.540,00 / € 352,00 / € 2.075,00 / € 266,00
LAZIO A, B, C / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
LAZIO B / € 2.256,25 / € 217,55 / € 925,30 / € 173,85
LIGURIA A / € 3.231,99 / € 321,24 / € 1.748,49 / € 225,00
LIGURIA B / € 3.555,19 / € 353,36 / € 1.923,34 / € 247,50
LOMBARDIA DEA / € 2.869,35 / € 263,26 / € 1.868,22 / € 204,20
LOMBARDIA PS / € 2.785,78 / € 263,26 / € 1.813,81 / € 204,20
LOMBARDIA / € 2.702,21 / € 255,36 / € 1.759,40 / € 198,07
MARCHE A / € 3.433,55 / € 321,18 / € 1.056,56 / € 201,11
MARCHE B / € 3.147,42 / € 294,42 / € 1.056,58 / € 201,11
MARCHE C / € 2.861,29 / € 267,65 / € 1.056,56 / € 203,11
MOLISE A / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
MOLISE B / € 2.018,75 / € 194,65 / € 827,90 / € 155,55
PIEMONTE / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
PIEMONTE PRIVATE A / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
PIEMONTE PRIVATE B / € 2.185,00 / € 210,68 / € 896,08 / € 168,36
PIEMONTE PRIVATE C / € 2.018,75 / € 194,65 / € 827,90 / € 155,55
PUGLIA / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
PUGLIA A - private / € 2.327,50 / € 224,42 / € 955,00 / € 179,00
PUGLIA B - private / € 2.185,00 / € 210,68 / € 896,00 / € 168,00
PUGLIA C - private / € 2.018,75 / € 194,65 / € 828,00 / €156,00
SARDEGNA / € 3.005,74 / € 321,23 / € 1.761,75 / € 243,76
SICILIA A / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
SICILIA B / € 2.339,38 / € 225,57 / € 959,39 / € 180,26
SICILIA C / € 2.244,38 / € 216,41 / € 920,43 / € 172,94
TOSCANA A / € 2.864,00 / € 275,00 / € 2.145,00 / € 275,00
TOSCANA B / € 2.520,00 / € 242,00 / € 1.888,00 / € 242,00
TOSCANA AREA VASTA / € 2.864,00 / € 275,00 / € 2.145,00 / € 275,00
TRENTO A / € 4.902,64 / € 487,14 / € 1.526,15 / € 264,04
TRENTO B / € 4.487,80 / € 445,92 / € 1.397,01 / € 241,70
TRENTO C / € 3.959,82 / € 393,46 / € 1.232,66 / € 213,27
UMBRIA A / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
UMBRIA B / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
UMBRIA C / € 2.375,00 / € 229,00 / € 974,00 / €183,00
VALLE D'AOSTA A / € 2.375,00 / € 229,00 / € 974,00 / € 183,00
VALLE D'AOSTA B / € 2.208,75 / € 212,97 / € 905,82 / € 170,19
VENETO / € 2.785,78 / € 200,00 / €1.281,87 / € 200,00
Mean value / € 2.652,96 / € 251,15 / €1.226,12 / € 196,18

d) Health Care Utilization: Spain

DRGs for AF-related hospitalisations
DESCRIPTION / Tariff (€)
Hospitalization-Arrhythmia with complications / DRG 138-ARRITMIAS CARDIACAS & TRASTORNOS DE CONDUCCION CON CC / 2837.67
Hospitalization-Arrhythmia w/o complications / DRG 139-ARRITMIAS CARDIACAS & TRASTORNOS DE CONDUCCION SIN CC / 2336.69
Hospitalization- Ablation / DRG 112-PROCEDIMIENTOS CARDIOVASCULARES PERCUTANEOS, SIN IAM, INSUFICIENCIA CARDIACA O SHOCK / 3328.16
Emergency department tariffs and outpatient visits (€ 2014)
Region / ED-VISIT / Outpatient Visits
Madrid (1) / 180 / 78
Catalonia (2) / 111.81 / 64.18
Basque Country (3) / 149.05 / 98.9
Galicia (4) / 261.08 / 35.19
Asturias (5) / 149.06 / 81.18
La Rioja (6) / 220.8 / 52.38
Aragón (7) / 136.79 / 83.63
CLM (8) / 236.09 / 91.06
Canary Islands (9) / 218.89 / 79.11
Ceuta/Melilla (10) / 202.39 / 92.62
CyL (11) / 101.41 / 137.99
Navarra (12) / 286.73 / 146.07
Cantabria (13) / 171.29 / 110.37
Murcia (14) / 203.71 / 101.86
Baleares (15) / 192.05 / 69.84
Andalusia (16) / 176.69 / 66.86
Extremadura (17) / 214.31 / 118.7
AVERAGE / € 187 / € 89

References

(1)ORDEN 731/2013, de 6 de septiembre, del Consejero de Sanidad, por la que se fijan los precios públicos por la prestación de los servicios y actividades de naturaleza sanitaria de la Red de Centros de la Comunidad de Madrid. Available at: Last access 30th of July.

(2)ORDRE SLT/106/2013, de 24 de maig, per la qual es determinen per a l'any 2013 els preus unitaris i la resta de valors a què es refereix l'article 5 del Decret 170/2010, de 16 de novembre, de regulació del sistema de pagament de serveis sanitaris en l'àmbit del Servei Català de la Salut. Available at Last access 30th of July.

(3)ACUERDO de 11 de marzo de 2013, del Consejo de Administración del Ente Público Osakidetza-Servicio vasco de salud, por el que se aprueban las tarifas por prestación de servicios sanitarios y docentes a terceros obligados al pago durante el ejercicio 2013. Available at Last access 30th of July.

(4)DECRETO 209/2011, de 27 de octubre, por el que se establecen las tarifas de los servicios sanitarios prestados en los centros dependientes del Servicio Gallego de Salud y en las fundaciones públicas sanitarias. Available at: Last access 30th July.

(5)Decreto 87/2009, de 29 de julio, por el que se establecen los precios públicos a aplicar por el Servicio de Salud del Principado de Asturias por la prestación de servicios sanitarios. Available at Last access 30th July.

(6)Resolución número 169, de 26 de enero de 2012, del Consejero de Salud y Servicios Sociales por la que se dispone la publicación de las tarifas por servicios sanitarios prestados a particulares en los centros del Servicio Riojano de Salud. Available at: Last access 30th July.

(7)RESOLUCIÓN de 30 de julio de 2012, de la Dirección Gerencia del Servicio Aragonés de Salud, sobre revisión de las tarifas a aplicar por la prestación de servicios sanitarios a terceros obligados al pago o a usuarios sin derecho a asistencia sanitaria en la Comunidad Autónoma de Aragón. Available at Last access 30th July.

(8)Resolución de 02/08/2013, de la Dirección Gerencia, sobre precios a aplicar por sus centros sanitarios a terceros obligados al pago o a los usuarios sin derecho a asistencia sanitaria. Available at Last access 30th July

(9)Resolución de 1 de febrero de 2013, de la Directora, por la que se modifica la cuantía de los precios públicos de servicios sanitarios previstos en el Decreto 81/2009, de 16 de junio, por el que se establecen los precios públicos de los servicios sanitarios prestados por el Servicio Canario de la Salud y se fijan sus cuantías. Available at Last access 30th July.

(10)Resolución de 19 de julio de 2013, del Instituto Nacional de Gestión Sanitaria, sobre revisión de precios a aplicar por los centros sanitarios del Instituto Nacional de Gestión Sanitaria en Ceuta y Melilla, por las asistencias prestadas en los supuestos cuyo importe ha de reclamarse a los terceros obligados al pago o a los usuarios sin derecho a la asistencia sanitaria de la Seguridad Social, así como por los servicios prestados por el Centro Nacional de Dosimetría y por la reproducción de documentos de la biblioteca de la entidad gestora. Available at Last access 30th July.

(11) DECRETO 25/2010, de 17 de junio, por el que se actualizan los precios públicos por actos asistenciales y servicios sanitarios prestados por la Gerencia Regional de Salud de Castilla y León. Available at Last access 30th July.

(12) Resolución 882/2010, de 3 de mayo, del director gerente del servicio navarro de saludosasunbidea, por la que se actualizan las tarifas por prestación de servicios en los centros y establecimientos asistenciales del servicio navarro de salud osasunbidea. Available at Last access 30th July.

(13)Orden SAN/12/2011, de 20 de abril, por la que se fi jan las cuantías de los precios públicos de los Servicios Sanitarios prestados por el Servicio Cántabro de Salud. Available at access 30th July.

(14)Orden de 24 de enero de 2011 de la Consejería de Economía y Hacienda, por la que se publican las tarifas de las tasas y precios públicos aplicables en el 2011. Available at Last access 30th July.

(15) Resolución del director general del Servicio de Salud de modificación de los anexos 1 y 2 de la Orden de la consejera de Salud y Consumo de 22 de diciembre de 2006. Available at Last access 30th July.

(16)ORDEN de 14 de octubre de 2005, por la que se fijan los precios p–blicos de los servicios sanitarios prestados por Centros dependientes del Sistema Sanitario P–blico de AndalucŒa. Available at Last access 30th July.

(17) ORDEN de 30 de enero de 2013 por la que se publican las tarifas actualizadas de las tasas y precios públicos de la Comunidad Autónoma de Extremadura, en virtud de lo dispuesto en la Ley 3/2012, de 28 de diciembre, de Presupuestos Generales de la Comunidad Autónoma de Extremadura para 2013. Available at Last access 30th July.