Abstract
BackgroundOral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. Due to high recurrence rate, close follow-up is mandatory. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume.MethodsFrom the National Health Insurance Research Database published by the Taiwanese National Health Research Institute, the authors selected a total of 1300 oral cancer patients who underwent tumor resection and free flap reconstruction in 2008. Hierarchical linear regression analysis was subsequently performed to explore the relationship between provider volume and expenditures of oncological surgery and one-year follow-up period. Emergency department (ED) visits and 30-day readmission rates were also analyzed.ResultsThe mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up. For oncological surgery expenditure, oral cancer patients treated by low-volume surgeons had an additional $845 than those in high-volume surgeons in mixed model. For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons. Oral cancer patients treated in low-volume hospitals incurred higher risk of 30-day readmission rate (odds ratio, 6.6; 95% confidence interval, 1.6–27).ConclusionsAfter adjusting for physician, hospital, and patient characteristics, low-volume provider performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher expenditure for oncological surgery and one-year healthcare per patient than did others with higher volumes. Treatment strategies adapted by high-volume providers should be further analyzed.
Highlights
Oral cancer is among the 10 most common forms of cancer [1]
We further reported the visits to the emergency department (ED) and readmission to the hospital within 30 days after discharge from oncological surgery as the outcomes of care between different caseload groups in order to confirm whether lower costs may lead to higher Emergency department (ED) visits or readmission rate in the follow-up period [21]
Oral cancer patients treated by low-volume surgeons were more likely to have low socioeconomic status (SES), resided in northern and southern/eastern Taiwan, and underwent treatment in regional hospitals, compared with those treated by high-volume surgeons
Summary
Oral cancer is among the 10 most common forms of cancer [1]. Of all cancers in Taiwanese males, oral cancer has been ranked fourth in incidence and mortality since 1995. An increasing number of young patients with oral cancer has been observed [4]. The increasing economic burden of oral cancer treatment is an obvious consequence [5,6]. The main treatment modality of oral cancer is wide resection of the tumor and reconstruction with or without adjuvant chemo-radiotherapy. With advances in the resection of tumors and flap reconstruction, economic and functional outcomes have become more important [2,4]. Oral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume
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