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Purpose: Due to increasing cost pressure in the public health system treatments and their costs are highly relevant in the therapy for chronic diseases such as glaucoma. In the era of diagnosis-related group (DRG) reimbursement, new interventions need to prove not only their safety and effectiveness but also their cost-utility. Canaloplasty as a new interventional surgery is compared to trabeculectomy (TE) by means of a cost and effort analysis., Methods: In this retrospective, consecutive case series patients were compared as follows: group I, 21 eyes of 21 patients undergoing canaloplasty from 2009 on and group II, 48 eyes of 42 patients, who were treated with TE with mitomycin C (MMC) from 2001 to 2004 and had intensified postoperative care. Data regarding demography, duration of hospitalisation, duration of surgery, surgical complications and interventions, and pre- and post-operative IOP were analysed within the first 6 months post operation., Results: In group I mean duration of hospitalisation was 5.3 ± 0.8 days (d) and in group II 10.7 ± 2.8 d. Duration of surgery was 77 ± 14 min in group I and in group II 48 ± 11 min. On average 2.8 ± 1.0 visits were needed during follow-up in group I and 6 ± 1.5 visits in group II. The mean preoperative IOP of 28.75 ± 9.6 mmHg was lowered to 12.8 ± 3.3 mmHg after six months in group I and in group II from 34.5 ± 13.4 mmHg to 10.3 ± 4.5 mmHg. In group I, a total of 4 interventions were seen within the first six months without re-admission. In group II 107 interventions and eleven re-admissions were necessary. Mean costs for hospitalisation amount to 821.50 € in group I and 1658.50 € in group II. Overall expenses were 2379.62 € for canaloplasty and 2733.61 € for TE., Conclusion: Both interventions could effectively control IOP. However, trabeculectomy requires a longer hospitalisation, has higher re-admission rates and needs more frequent postoperative controls, which makes TE more costly and time-consuming than canaloplasty., (Georg Thieme Verlag KG Stuttgart · New York.)

Replacement of the anterior cruciate ligament (ACL) is presently routinely carried out with autologous transplantation of the ligamentum patellae (LP), semintendinosus-gracilis (SGS) or quadriceps (QS) tendons. The anatomical positioning of the drilling canals, transplant fixation, complication rate, revision aspects as well as economic aspects are still under discussion. Fixation of the transplant can be carried out mechanically with various anchoring systems or using biological implant-free healing (free of cost). The compulsory and private health insurance companies as well as staff medical insurance associations guarantee a constant remuneration according to the EBM (uniform evaluation standard), GOA (scale of fees for physicians) or UV-GOA (accident insurance scale of fees for physicians). At present all health insurances accept the costs for implantations in outpatient areas (minus 25 Euro own contribution for compulsory health insurance). For inpatient treatment remuneration is according to the flat-rate scale (diagnosis-related groups). Costs for implants, which are increasing over the years, diminish the economic result in this case. The technique of implant-free replacement of ACLs is cheaper, with fewer complications and achieves functional results for fixation of the transplant which are comparable to techniques with implants. This also applies to the double bundle technique. Implant-free replacement of ACLs with the patellar tendon is a suitable, uncomplicated operation technique with comparably low costs and belongs to the state of the art according to Hertel, Petersen and other authors. This method already has a valuable place in surgery of the ACL.

Objective: To evaluate the possibilities for cost reduction in spinal surgery by analysing implant costs and the efficiency of each type of implant., Materials and Methods: The costs of spinal implant methods, as well as Halo-vest for craniocervical, cervical, thoracic, lumbar spine are summarised according to an analysis of price lists from 2001 and 2002. The different methods were additionally evaluated with regard to the scientifically-based treatment efficiency. All prices above 100 euro were rounded up to the closest 50 euro. For the implants, a literature research was performed. The scientific papers were divided into groups according to their level of evidence (I a -IV), and then further subdivided into comparable and non-comparable categories., Results: Craniocervical: Halo-vest 1,700-2,500 euro, odontoidscrew 100-250 euro, plate 1,300 euro, wire 20-250 euro; plate-wire-, rod-wire- or rod-screw systems 400-1,800 euro, clamps 1,200 euro, Cervical: placeholder 20-500 euro, vertebral body replacement 400-1,300 euro, plate 75-450 euro; rod- or plate-screw systems 900-1,700 euro; Thoracic/lumbar: plate/rod-systems 1,000-2,800 euro, vertebral body replacement 500-1,300 euro, internal fixateur 800-2,500 euro, cages 600-1,500 euro. For none of the implant methods were comparable scientific clinical publications found with a high levels of evidence (I a-I b)., Conclusions: Costs can be reduced through a more thorough investigation and corresponding choice of implant method. The cost-benefit analysis of new spinal implants must be considered more with regard to the evidence-based spinal surgery. In order to sufficiently evaluate the different treatment methods, future multicenter controlled comparable studies and meta-analyses must be undertaken.

Long-term dopaminergic treatment of Parkinson's disease is complicated by the occurrence of dyskinesia and motor fluctuations and is responsible for increasing the costs of treatment. In these patients, continuous subcutaneous therapy with the dopamine agonist apomorphine or deep-brain stimulation represents a promising strategy. While the costs for the treatment with apomorphine are covered by health insurance, separate reimbursement for deep-brain stimulation does not exist in Germany. The case reports (n = 3) presented here emphasize that deep-brain stimulation is less cost-intensive than subcutaneous treatment with apomorphine in selected patients. Even in the first postoperative year costs for medication and hospital stays were reduced by approximately 60%. Moreover, in all three patients, motor complications improved after deep-brain stimulation in comparison to previous subcutaneous application of apomorphine. Thus, to further ensure deep-brain stimulation in parkinsonian patients it is mandatory to find a mode of reimbursement for the institutions concerned.

During the past three decades, the use of implants both in urology and other surgical specialties has experienced exponential growth. The development of implantable genitourinary prostheses has similarly grown from simple testicular substitutes to the large group of implantable penile prostheses, artificial urinary sphincters, prostheses in neurology, and possible future developments of artificial bladder and ureteral materials. The majority of urologic prostheses are constructed of silicone, because it is relatively inert, but nevertheless silicone causes some local tissue reactions and deteriorates with time. Currently, much research is underway studying the effects on the human host. Although multiple mechanical malfunctions of these prosthetic devices have occurred, periprosthetic infection is the most disastrous complication which usually leads to removal of the prostheses. This article gives the clinician an overview of common complex urologic implants, especially the current development of prostheses in the field of neurology.