Hospitalization cost trends for patients with impacted teeth: a double-breakpoint interrupted time series analysis

Ni An, Liangmei Jiang, Yuanbo Song, Ran Xiang, Junhua Zhang, Yiyang Wang, F F Li

Objective To evaluate the impact of Diagnosis-Related Group (DRG) payment reform and clinical pathway management on the hospitalization costs and cost structures for patients with impacted teeth. Methods We analyzed admission data for 1,206 patients with impacted teeth at a Grade A tertiary public hospital in City L from September 1, 2021, to December 31, 2024. A double-breakpoint interrupted time series analysis was employed to assess level and trend changes in total and component costs. Intervention points were set at August 1, 2022 (DRG reform), and September 1, 2023 (clinical pathway management). Results Prior to the DRG reform, consumable costs trended upward while nursing costs trended downward ( p < 0.05). After the DRG reform, nursing costs transitioned to a significant increasing trend ( p < 0.05). Following the implementation of clinical pathway management, significant decreasing trends were observed across total hospitalization costs, consumable costs, treatment costs, nursing costs, general medical service costs, total insurance payments, and out-of-pocket expenses ( p < 0.05). Conclusion DRG reform alone was not associated with a significant reduction in hospitalization costs for patients with impacted teeth during the initial implementation phase. However, when integrated with clinical pathway management, the results suggested an association between the combined implementation and optimized cost structure as well as reduced hospital stays. Given the limitations of a single-center design and quasi-experimental design, these findings should be interpreted as associational evidence, and further research is warranted to validate its impact on clinical quality.