Abstract
In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.
Highlights
The oral cavity is anatomically connected to the lungs through the pharynx, larynx, trachea, and bronchi
The potential factors related to postoperative pneumonia among cancer patients
A multicenter study that used Diagnosis Procedure Combination (DPC) data from approximately 25,000 postoperative cancer patients statistically found that the introduction of perioperative oral management (POM) had contributed to the reduction in the incidence rate of postoperative pneumonia, the mortality rate, and the duration of hospitalization
Summary
The oral cavity is anatomically connected to the lungs through the pharynx, larynx, trachea, and bronchi. Contaminants within the oral cavity have the potential to cause pneumonia. The risk of pneumonia in the oral cavity is compensated by the process of swallowing; a deterioration in the function of swallowing increases the risk of pneumonia, aspiration pneumonia [1,2]. Teramoto et al [3] investigated the occurrence of pneumonia in healthcare facilities, where the indoor environment is maintained relatively clean, and reported that more than 80% of elderly patients with pneumonia presented with aspiration pneumonia. The risk of pneumonia increases after surgical treatment. In a study comprising approximately 2.5 million cancer patients aged 18 years or older who received surgery, the incidence of postoperative pneumonia was reported to be 3.5% [4]. The prevention of pneumonia in hospitalized patients, especially those with malignant tumors, is an important issue in Japan
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