Summary
Cost accounting has shown that the volume of tissue to be treated is the decisive
factor in determining the cost of radioiodine therapy (RAITh). In the case of large
goitres, the costs of excision (5.185 DM) and radioiodine therapy (5.562 DM) are,
to a large extent, equivalent. Under the 1993 regulations for radiation protection,
RAITh was cost-effective for treatment of toxic multinodular goitres up to volumes
of 57 ml. However, new maximum permissible levels of radioactivity on discharge from
hospital (250 MBq iodine-131 residual activity) have raised this threshold volume
to 90 ml. In Germany, remuneration for a goitre resection is calculated from standard
charges for total treatment without any consideration of the size and spectrum of
medical services offered by different clinics, while remuneration for RAITh comes
from payments for basic and specific, departmental medical services. University clinics
with departments of nuclear medicine have relatively high basic costs. In the first
quarter of 1998, the length of hospitalisation after RAITh (for all indications combined)
was 4.6 days in university hospitals in Germany. Owing to this shorter length of hospitalisation,
the payments received in some clinics fell far short of the total costs of this treatment
calculated by cost accounting.
Key words
Goitre - hyperthyroidism - operation - radioiodine - costs
