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A financial analysis of Hodgkin lymphoma staging.

M P Corder, P A Lachenbruch, S G Lindle, J H Sisson, P S Johson and J T Kosier

A clinical algorithm was developed for staging of Hodgkin disease. This represented the treatment logic employed in a specified time period and was used to categorize charges incurred in the staging of 50 consecutive patients who underwent this process at a university hospital. Charges were categorized as: necessary (in concordance with the algorithm), justifiable (a result of care for a separate medical disorder or for consideration of distance), and perceived excess (neither necessary nor justifiable). Thirty per cent of the total charges were identified as perceived excess. Hospitalization accounted for 68 per cent and laboratory charges 22 per cent of the perceived excess charges. Fifty-eight per cent of the patients had a percentage of perceived excess bed charges exceeding 30 per cent of the total. Perceived excess medical hospitalization correlated positively with time from diagnosis to treatment decision. It is recommended that attempts to reduce the expense of Hodgkin lymphoma staging be directed at decreasing hospitalization.