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Cost-analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancy: An Australian perspective with global application.
- Source :
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European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 Apr; Vol. 47 (4), pp. 828-833. Date of Electronic Publication: 2020 Sep 15. - Publication Year :
- 2021
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Abstract
- Background: Cost-effective cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of patients with peritoneal malignancy remains an ongoing financial challenge for healthcare systems, hospitals and patients. This study aims to describe the detailed in-hospital costs of CRS and HIPEC compared with an Australian Activity Based Funding (ABF) system, and to evaluate how the learning curve, disease entities and surgical outcomes influence in-hospital costs.<br />Methods: A retrospective descriptive costing review of all CRS and HIPEC cases undertaken at a large public tertiary referral hospital in Sydney, Australia from April 2017 to June 2019. In-hospital cost variables included staff, critical care, diagnosis, operating theatre, and other costs. Univariate and multivariate analyses were conducted to investigate the differences between actual cost and the provision of funding, and potential factors associated with these costs.<br />Results: Of the 118 CRS and HIPEC procedures included in the analyses, the median total cost was AU$130,804 (IQR: 105,744 to 153,972). Provision of funding via the ABF system was approximately one-third of the total CRS and HIPEC costs (p < 0.001). Surgical staff proficiency seems to reduce the total CRS and HIPEC costs. Surgical time, length of intensive care unit and hospital stay are the main predictors of total CRS and HIPEC costs.<br />Conclusion: Delivery of CRS and HIPEC is expensive with high variability. A standard ABF system grossly underestimates the specific CRS and HIPEC funding required with supplementation essential to sustaining this complex highly specialised service.<br />Competing Interests: Declaration of competing interest None.<br /> (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Aged
Australia
Clinical Competence
Costs and Cost Analysis
Critical Care economics
Diagnostic Techniques and Procedures economics
Female
Financing, Government methods
Health Personnel economics
Humans
Learning Curve
Length of Stay economics
Male
Middle Aged
Operating Rooms economics
Operative Time
Peritoneal Neoplasms diagnosis
Retrospective Studies
Cytoreduction Surgical Procedures economics
Hospital Costs statistics & numerical data
Hospitals, Public economics
Hyperthermic Intraperitoneal Chemotherapy economics
Peritoneal Neoplasms economics
Peritoneal Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2157
- Volume :
- 47
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 32972815
- Full Text :
- https://doi.org/10.1016/j.ejso.2020.09.010