Cost analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and the risk factors for their increased cost in a public insurance health care system - Single centre study
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
31982207
DOI
10.1016/j.ejso.2020.01.020
PII: S0748-7983(20)30021-4
Knihovny.cz E-resources
- Keywords
- Cost analysis, Cytoreductive surgery, Intraperitoneal hyperthermic chemotherapy, Postoperative complications,
- MeSH
- Cytoreduction Surgical Procedures economics MeSH
- Length of Stay economics statistics & numerical data MeSH
- Diagnostic Imaging economics MeSH
- Adult MeSH
- Pharmaceutical Services economics MeSH
- Financing, Government * MeSH
- Healthcare Financing MeSH
- Hyperthermia, Induced economics MeSH
- Intensive Care Units economics statistics & numerical data MeSH
- Colorectal Neoplasms pathology MeSH
- Blood Loss, Surgical statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Appendiceal Neoplasms pathology MeSH
- Ovarian Neoplasms pathology MeSH
- Costs and Cost Analysis MeSH
- Peritoneal Neoplasms secondary therapy MeSH
- Postoperative Complications economics epidemiology MeSH
- Aged MeSH
- Insurance, Health, Reimbursement statistics & numerical data MeSH
- Equipment and Supplies, Hospital economics MeSH
- Insurance, Health * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic epidemiology MeSH
INTRODUCTION: This study aimed to evaluate the costs of CRS and HIPEC and treatment of the related postoperative complications in the public healthcare system. We also aimed to identify the risk factors that increase the cost of CRS and HIPEC. MATERIALS AND METHODS: We retrospectively evaluated 80 patients who underwent CRS and HIPEC between February 2016 and November 2018 in the Department of Surgery, University Hospital of Olomouc, Czech Republic. Intraoperative factors and postoperative complications were assessed. The treatment cost included the surgery, hospital stay, intensive care unit (ICU) admission, pharmaceutical charges including medication, hospital supplies, pathology, imaging, and allied healthcare services. RESULTS: The postoperative morbidity rate was 50%, and the mortality rate was 2.5%. The mean length of hospitalisation and ICU admission was 15.44 ± 8.43 and 6.15 ± 4.12 for all 80 patients and 10.73 ± 2.93 and 3.73 ± 1.32, respectively, for 40 patients without complications, and 20.15 ± 13.93 and 8.58 ± 6.92, respectively, for 40 patients with complications. The total treatment cost reached €606,358, but the total reimbursement was €262,931; thus, the CRS and HIPEC profit margin was €-343,427. Multivariate analysis showed that blood loss ≥1.000 ml (p = 0.03) and grade I-V Clavien-Dindo complications (p < 0.001) were independently associated with increased costs. CONCLUSION: The Czech public health insurance system does not fully compensate for the costs of CRS and HIPEC. Hospital losses remain the main limiting factor for further improving these procedures. Furthermore, treatment costs increase with increasing severity of postoperative complications.
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