PGI24 EPISODE OF CARE COSTS ASSOCIATED WITH MINIMALLY INVASIVE COLON SURGERY: A PROPENSITY-MATCHED ANALYSIS USING MEDICARE AND COMMERCIAL CLAIMS DATA

Abstract

The objective of this study was to evaluate post-index six-month Episode of Care (EOC) costs to both Medicare and a commercial payer among patients undergoing inpatient minimally invasive colon surgery (MIS). This study assessed index admission and post-index outcomes such as total episode of care cost and hospital length of stay (LOS), all-cause ER visit rates and costs, and all-cause inpatient readmission rates and costs at 5-day, 30-day, 90-day, and 6-month post-index periods. Adult Medicare and commercial beneficiaries who received minimally invasive sigmoid, left or right colon surgery, identified by ICD-10 procedure codes between January 1, 2016 and December 31, 2017 were included in the analysis. Exclusion criteria for this study included presence of rectal cancer at index and missing cost information for index procedures. Cost estimates represent claims data from Medicare and/or a commercial health plan. Two cohorts were created based on use of near-infrared fluorescence (NIF) and four sub-cohorts based on the use of NIF and the presence of robotics (R). Statistical analyses included Pearson’s chi-squared tests, propensity score matching, a stepwise approach, ANOVA and the Mann-Whitney U test. Average EOC costs were lower although not statistically different (all ps>0.05) for the NIF cohort at 30-day, 90-day, and 6-month post-index periods by 17%, 19%, and 23%, respectively when compared to the NoNIF cohort. Post hoc cohort comparisons found the NIF-NoR cohort had lower costs than the NIF-R cohort at 30-day, 90-day, and 6-month time intervals by 16% 28% and 14% (all ps>0.05), respectively. Implementing NIF imaging during MIS may potentially reduce short- and long-term EOC costs due to lower average LOS, ER visits and inpatient readmissions. Hospitals may want to consider these EOC cost findings in addition to capital equipment and disposable costs when evaluating technologies for minimally invasive colon surgery.