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.
Open Access
|