Retrograde intrarenal surgery: analysis of costs and correspondence between the clinical-statistical group tariff and actual expenses in a federal medical institution in St. Petersburg

Gadzhiev N.K., Petrov A.D., Burlykin V.S., Shkarupa A.A., Gorgotsky I.A., Gorelov D.S., Semenyakin I.V., Akopyan G.N., Malkhasyan V.A., Martov A.G.

1) N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, Saint Petersburg, Russia; 2) Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia; 3) MEDSI Clinical and Diagnostic Center, Moscow, Russia; 4) Institute of Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia; 5) Russian University of Medicine, Moscow, Russia; 6) S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department, Moscow, Russia; 7) A.I. Burnazyan Federal Medical Biophysical Center, Federal Medical-Biological Agency of Russia, Moscow, Russia; 8) Medical Research and Education Center, M.V. Lomonosov Moscow State University, Moscow, Russia; 9) Central Clinical Hospital of Civil Aviation, Moscow, Russia

Introduction. RIRS is one of the main treatment options for urolithiasis. However, its high resource utilization and increasing number of procedures raise concerns regarding the sufficiency of reimbursement within the obligatory medical insurance (OMI) system. From 2022 to 2025, OMI tariffs for RIRS have shown steady growth, driven by the transition of the procedure to higher-reimbursed disease-related group (DRG groups). Nevertheless, despite the increase in tariffs, the issue of their adequacy for covering the costs of high-complexity interventions persists.
Aim. To analyze the sufficiency of the DRG tariff to compensate for the actual costs of performing RIRS of varying complexity levels in a federal medical institution in St. Petersburg.
Materials and methods. A cost analysis of 157 RIRS cases performed in 2024 at the N.I. Pirogov High Medical Technologies Clinic, St. Petersburg State University, was conducted. Costs were categorized as direct and indirect. The actual expenses were compared with the disease-related group (DRG) tariff.
Results. The average costs per treated RIRS case ranged from 139,000 to 180,000 rubles, depending on the complexity category. Direct costs accounted for 88–91% of the total expenditures. The DRG tariff (147,000 rubles) covered only the expenses for low-complexity (Category I) procedures. In more complex cases, the actual costs exceeded the tariff by 11.5–22.4%. As a result, for 83% of patients treated with RIRS at the clinic, the established tariffs were insufficient to reimburse the actual expenses, leading to a deficit of 3.01 million rubles.
Conclusion. In order to increase the economic sustainability of clinics operating under the DRG-based payment system, the possibility of introducing new reimbursement mechanisms is being considered. In particular, it is proposed to use differentiated values of the coefficient of complexity of patient treatment in the provision of RIRS procedures, depending on the appropriate category of complexity. For regional medical organizations with their own payment system (Moscow and St. Petersburg), it is recommended to provide tariffs that cover costs for all categories of RIRS complexity.

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About the Authors

Corresponding author: A.D. Petrov – Urologist, N. I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University; Saint Petersburg, Russia; e-mail: urology@spbpetrov.ru

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