Cost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument. Issue 12 (16th July 2014)

• Record Type: Journal Article
• Authors: Sutton, Jeffrey M.; Wilson, Gregory C.; Paquette, Ian M.; Wima, Koffi; Hanseman, Dennis J.; Quillin, R. Cutler; Sussman, Jeffrey J.; Edwards, Michael J.; Ahmad, Syed A.; Shah, Shimul A.; Abbott, Daniel E.
• Is Part Of: HPB. Volume 16:Issue 12(2014:Dec.)
• Page Start: 1056
• Page End: 1061
• Publication Date: 2014-07-16
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12309
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: The cost implication of variability in pancreatic surgery is not well described. It was hypothesized that for a pancreaticoduodenectomy (PD), lower volume centres demonstrate worse peri‐operative outcomes at higher costs. Methods: From 2009–2011, 9883 patients undergoing a PD were identified from the University HealthSystems Consortium (UHC) database and stratified into quintiles by annual hospital case volume. A decision analytic model was constructed to assess cost effectiveness. Total direct cost data were based on Medicare cost/charge ratios and included readmission costs when applicable. Results: The lowest volume centres demonstrated a higher peri‐operative mortality rate (3.5% versus 1.3%, P < 0.001) compared with the highest volume centres. When both index and readmission costs were considered, the per‐patient total direct cost at the lowest volume centres was $23 005, or 10.9% (i.e. $2263 per case) more than at the highest volume centres. One‐way sensitivity analyses adjusting for peri‐operative mortality (1.3% at all centres) did not materially change the cost effectiveness analysis. Differences in cost were largely recognized in the index admission; readmission costs were similar across quintiles. Conclusions: For PD, low volume centres have higher peri‐operative mortality rates and 10.9% higher cost per patient. Performance of PD at higher volume centres can lead to both better outcomes and substantial cost savings.