PD39-07 SURGEON VARIATION IN THE COSTS OF RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2016PD39-07 SURGEON VARIATION IN THE COSTS OF RADICAL CYSTECTOMY Jeffrey Leow, Alexander Cole, Steven Chang, Christian Meyer, Adam Kibel, Mani Menon, Thomas Seisen, Jesse Sammon, Mark Preston, Benjamin Chung, Maxine Sun, and Quoc-Dien Trinh Jeffrey LeowJeffrey Leow More articles by this author , Alexander ColeAlexander Cole More articles by this author , Steven ChangSteven Chang More articles by this author , Christian MeyerChristian Meyer More articles by this author , Adam KibelAdam Kibel More articles by this author , Mani MenonMani Menon More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Jesse SammonJesse Sammon More articles by this author , Mark PrestonMark Preston More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Maxine SunMaxine Sun More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1513AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In a cost-conscious healthcare environment, identifying unwarranted costs and cost variability is paramount. Bladder cancer (BCa) incurs the highest lifetime treatment costs per patient of all cancers and radical cystectomy (RC), as a cornerstone of BCa treatment, is a major contributor. Under these premises, the aim of the current study was to assess individual surgeon-level variations and identify independent predictors of high- and low-cost RC. METHODS We queried the Premier all-payer discharge database to accrue a study cohort of a weighted sample of 11,225 individuals who underwent RC by 292 unique surgeons at 144 different hospitals between 2003 and 2013. Surgeon and hospital volume as well as 90-day direct hospital costs (2014 US$) were ranked and divided into high and low volume, and high and low costs. High volume and costs were defined as values above the 90th percentile while low volume and costs corresponded to costs and volume below the 10th percentile. Multivariable logistic regression models identified independent predictors of high and low costs, while multilevel hierarchal models determined variability of various characteristics on costs. RESULTS Mean 90-day direct hospital costs for each RC patient was $32,261 (95% CI $31220 - $33,302). There were 70 surgeons whose mean costs associated with each RC fell in the lowest decile of costs (<$16,278), with mean costs of $13,654 (95% CI: $13,191 to $14,116). There were 113 surgeons with mean costs for each RC in the top decile (>$51,285), with mean costs of $82,642 (95% CI: $76541 to $88744). Factors associated with high costs include worse comorbidity profile (vs. no comorbidity: OR 3.45, 95% CI 2.21- 5.38, p<0.0001) and laparoscopic approach (vs. open: 2.83, 95% CI: 1.52 to 5.27, p=0.0004). We found that patient, hospital and surgeon characteristics had a modest effect on the variability of costs (4.9%, 2.1%, 0.6% respectively). However, the presence of a 90-day major complication after RC and a prolonged postoperative length of stay contributed substantially to the overall cost variability (18.1% and 18.2% respectively). CONCLUSIONS There was a nearly 6-fold difference in costs between the most and least costly surgeons performing RC. There appears to be a key role played by individual surgeons across a large nationally representative sample. Given the modest variability in costs contributed by hospital and surgeon characteristics, the avoidance and prompt management of major complications may be key to reduce unwarranted variability in BCa/RC costs. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e932 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jeffrey Leow More articles by this author Alexander Cole More articles by this author Steven Chang More articles by this author Christian Meyer More articles by this author Adam Kibel More articles by this author Mani Menon More articles by this author Thomas Seisen More articles by this author Jesse Sammon More articles by this author Mark Preston More articles by this author Benjamin Chung More articles by this author Maxine Sun More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...