Variability and opportunity costs among the surgical alternatives for breast cancer


Por: Angulo-Pueyo E, Ridao-López M, Martínez-Lizaga N, García-Armesto S and Bernal-Delgado E

Publicada: 1 may 2014
Categoría: Public Health, Environmental and Occupational Health

Resumen:
Objective: To analyze medical practice variation in breast cancer surgery (either inpatient-based or day-case surgery), by comparing conservative surgery (CS) plus radiotherapy vs. non-conservative surgery (NCS). We also analyzed the opportunity costs associated with CS and NCS. Methods: We performed an observational study of age- and sex-standardized rates of CS and NCS, performed in 199 Spanish healthcare areas in 2008-2009. Costs were calculated by using two techniques: indirectly, by using All-Patients Diagnosis Related Groups (AP-DRG) based on hospital admissions, and directly by using full costing from the Spanish Network of Hospital Costs (SNHC) data. Results: Standardized surgery rates for CS and NCS were 6.84 and 4.35 per 10,000 women, with variation across areas ranging from 2.95 to 3.11 per 10,000 inhabitants. In 2009, 9% of CS was performed as day-case surgery, although a third of the health care areas did not perform this type of surgery. Taking the SNHC as a reference, the cost of CS was estimated at 7,078 (sic) and that of NCS was 6,161 (sic). Using AP-DRG, costs amounted to 9,036 (sic) and 8,526 (sic), respectively. However, CS had lower opportunity costs than NCS when day-case surgery was performed frequently-more than 46% of cases (following SNHC estimates) or 23% of cases (following AP-DRG estimates). Conclusions: Day-case CS for breast cancer was found to be the best option in terms of opportunity-costs beyond a specific threshold, when both CS and NCS are elective. (C) 2013 SESPAS. Published by Elsevier Espana, S.L. All rights reserved.
ISSN: 02139111





GACETA SANITARIA
Editorial
ELSEVIER, 685 ROUTE 202-206, BRIDGEWATER, NJ 08807 USA, España
Tipo de documento: Article
Volumen: 28 Número: 3
Páginas: 209-214
WOS Id: 000335714700006
ID de PubMed: 24491512
imagen Open Access

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