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Table 2 Estimation of the contribution margin accrued by the outpatient chemotherapy sessions in France

From: Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts

  Hospital perspective National Health Insurance perspective Hospital perspective
  Total hospital costs associated with outpatient chemotherapy sessions (DRG 28Z07Z) Costs associated with expensive drugs** Costs associated with physician fees** Costs attributable to the administration of chemotherapy*** Amount/fee paid by the National Health Insurance Net contribution margin for public and private hospitals+
  Number of sessions performed in 2013# Unit hospital cost per DRG Total cost* Cost associated with expensive drugs Total cost Cost associated with physician fees Total cost associated with physician fees
Sector (A) (B) (A x B) (C) (A x C) (D) (A x D) (A x B) - ((A x C)+ (A x D)) = (E) (F)$ (F) – (E)
Public 1 511 364 922€ 1 393 477 068 € 546 € 825 355 880 € NA NA 568 121 728 € 599 059 349 € 30 937 621€
Private 710 500 823€ 584 741 500 € 566 € 401 787 750 € 31 € 22 025 500 € 160 928 250 € 216 503 560 € 55 575 310 €
Total 2 221 864 - 1 978 219 108€ - 1 227 143 630 € - 22 025 500 € 729 049 978 € 815,562,909 € 86 512 931 €
  1. NA: Not Applicable.
  2. DRG: Diagnosis Related Group.
  3. #The number of outpatient chemotherapy sessions was obtained from the 2013 National Hospital database (PMSI, 2013) [16].
  4. The unit hospital cost per DRG represents the average cost of hospital stay for the administration of anticancer treatments during outpatient hospitalization (without overnight hospital stay). Data was obtained from the National Scale of Costs (Etude Nationale des Coûts Complets, ENCC) (ENCC 2012 version v11f [18]) which is a survey conducted in France every two years in order to document cost incurred by hospitals for each Diagnosis Related Group (DRG). For each DRG, a mean hospital cost is calculated from a sample of public and private hospitals which participate to the survey.
  5. *The total cost incurred by hospitals for outpatient chemotherapy sessions (DRG 28Z07Z) was calculated by multiplying the unit hospital cost per DRG (A) by the number of sessions performed in each hospital sector (B).
  6. **The unit hospital cost per DRG () includes the cost associated with expensive drugs for public and private sectors and the costs associated with physician fees for public sector only.
  7. ***To estimate the cost only attributable to the administration of a chemotherapy session, the cost attributed to expensive drugs and to physicians fees should be removed. It represents the cost incurred by hospitals for the administration of cancer treatments (excluding the cost for expensive drugs and physicians fees which are paid by National Health Insurance above the DRG).
  8. +It represents the revenue received by hospitals under the activity of outpatient chemotherapy administration (expensive drugs and medical fees excluded).
  9. $See Table 1.