Trends in radiotherapy inpatient admissions in Germany: a population-based study over a 10-year period

Abstract

Objective: With the increasing complexity of oncological therapy, the number of inpatient admissions to radiotherapy and non-radiotherapy departments might have changed. In this study, we aim to quantify the number of inpatient cases and the number of radiotherapy fractions delivered under inpatient conditions in radiotherapy and non-radiotherapy departments.

Methods: The analysis is founded on data of all hospitalized cases in Germany based on Diagnosis-Related Group Statistics (G-DRG Statistics, delivered by the Research Data Centers of the Federal Statistical Office). The dataset includes information on the main diagnosis of cases (rather than patients) and the performed procedures during hospitalization based on claims of reimbursement. We used linear regression models to analyze temporal trends. The considered data encompass the period from 2008 to 2017.

Results: Overall, the number of patients treated with radiotherapy as inpatients remained constant between 2008 (N = 90,952) and 2017 (N = 88,998). Starting in January 2008, 48.9% of 4000 monthly cases received their treatment solely in a radiation oncology department. This figure decreased to 43.7% of 2971 monthly cases in October 2017. We found a stepwise decrease between December 2011 and January 2012 amounting to 4.3%. Fractions received in radiotherapy departments decreased slightly by 29.3 (95% CI: 14.0-44.5) fractions per month. The number of days hospitalized in radiotherapy departments decreased by 83.4 (95% CI: 59.7, 107.0) days per month, starting from a total of 64,842 days in January 2008 to 41,254 days in 2017. Days per case decreased from 16.2 in January 2008 to 13.9 days in October 2017.

Conclusion: Our data give evidence to the notion that radiotherapy remains a discipline with an important inpatient component. Respecting reimbursement measures and despite older patients with more comorbidities, radiotherapy institutions could sustain a constant number of cases with limited temporal shifts.

Keywords: DRG data; Germany; Inpatient cases; Non-radiotherapy departments; Radiotherapy departments.

Fig. 1

a Temporal course of cases with any form of radiotherapy treated in radiotherapy departments (red), non-radiotherapy departments (black), and other departments (blue). b Proportion of cases with any form of radiotherapy exclusively treated in radiotherapy departments. c Temporal course of cases with radiochemotherapy treated in radiotherapy departments (red), non-radiotherapy departments (black), and other departments (blue). d Proportion of cases with radiochemotherapy exclusively treated in radiotherapy departments

Fig. 2

a Temporal course of fractions in cases with any form of radiotherapy treated in radiotherapy departments (red), non-radiotherapy departments (black), and other departments (blue). b Proportion of cases with any form of radiotherapy exclusively treated in radiotherapy departments. c Temporal course of fractions in cases with radiochemotherapy treated in radiotherapy departments (red), non-radiotherapy departments (black), and other departments (blue). d Proportion of cases with radiochemotherapy exclusively treated in radiotherapy departments

Fig. 3

Temporal course of fractions per case differentiating between radiotherapy and non-radiotherapy department, estimates were obtained from linear regression models. CL Confidence limits, n‑RT non-radiotherapy departments, RT radiotherapy departments

Fig. 4

Days of hospitalization in radiotherapy departments differentiating between all radiotherapy and radiotherapy with simultaneous chemotherapy procedures, respectively. Absolute number (red), Smoothed temporal course (black) with 95% confidence intervals (green)

Fig. 5

a Days hospitalized in a radiotherapy department per bed in Germany, b Days hospitalized in a radiotherapy department per bed in Germany (radiochemotherapy only), c Sum of beds ascribed to radiotherapy departments in Germany. Blue line linear regression line

Fig. 6

Proportion of cases with chemotherapy in relation to all cases with radiotherapy

Fig. 7

Charlson Comorbidity Index (CCI) in relation to department across the observational period. Radiotherapy departments (red), other departments (black), and radiotherapy and other departments (blue)