PI-04 SURGEON AND HOSPITAL VARIATION IN THE COSTS OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN THE UNITED STATES

Abstract

You have accessJournal of UrologyBest Abstract1 Apr 2016PI-04 SURGEON AND HOSPITAL VARIATION IN THE COSTS OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN THE UNITED STATES Alexander Cole, Jeffrey Leow, Steven Chang, Christian Meyer, Nawar Hanna, Adam Kibel, Mani Menon, Jesse Sammon, Firas Abdollah, Benjamin Chung, Maxine Sun, and Quoc-Dien Trinh Alexander ColeAlexander Cole More articles by this author , Jeffrey LeowJeffrey Leow More articles by this author , Steven ChangSteven Chang More articles by this author , Christian MeyerChristian Meyer More articles by this author , Nawar HannaNawar Hanna More articles by this author , Adam KibelAdam Kibel More articles by this author , Mani MenonMani Menon More articles by this author , Jesse SammonJesse Sammon More articles by this author , Firas AbdollahFiras Abdollah 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.2016.02.1209AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In a cost-conscious healthcare environment, eliminating unwarranted costs and understanding cost variation are paramount. Prostate cancer is the most common malignancy among men and surgical treatment with radical prostatectomy (RP) is associated with substantial costs, particularly with the recent rapid adoption of robot-assisted RP (RARP). We sought to assess individual surgeon-level variation in costs of RARP and identify independent predictors of high and low-cost surgery. METHODS We identified 291,015 men in the Premier all-payer discharge database who underwent RARP for prostate cancer by 667 unique surgeons at 197 different hospitals across the United States from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 US$). High costs were defined as costs superior to the 90th percentile of all patient costs (≥$18,564/RARP), while low costs were defined as the costs inferior to the 10th percentile of all patient costs (≤$5,585/RARP). 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 costs for each RARP patient was $11,878 (95% CI 11,804-11,952), Mean costs per RARP in the low-cost group was $2837 (95% CI: $2805-$2869) compared to $25,906 (95% CI: $24702-$25490) in the high-cost group. Nearly a third of the variation in RARP cost was attributable to hospital characteristics, and over a fifth was attributable to surgeon characteristics (R-squared for each 30.43% and 21.25%, respectively). Factors associated with high-cost surgeries included Black race (vs. Whites; OR: 1.42, 95% CI: 1.12 to 1.33), Charlson comorbidity≥2 (vs. 0; OR 1.88 95% CI 1.55-2.29) and teaching hospitals (vs. non-teaching; OR 2.27, 95% CI 1.28-4.04). High-volume providers (≥90th percentile) was associated with significantly lower odds of high-cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105 95% CI 0.02-0.46). As for predictors for low-cost surgeries, high-volume surgeons were found to be less likely to have low-cost RARPs (OR: 0.41, 95% CI: 0.20-0.84). Conversely, high-volume hospitals were highly associated with low-cost RARPs (OR: 839, p<0.0001). CONCLUSIONS This study provides new insight into the key role played by individual surgeons performing RARP across a large nationally representative sample. Given the substantial variability in RARP costs contributed by hospital and surgeon characteristics, future steps to identify and remedy the root cause of outliers costs, and to reduce unwarranted variability in costs may yield great benefits for patients, physicians and the health system as a whole. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e410 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alexander Cole More articles by this author Jeffrey Leow More articles by this author Steven Chang More articles by this author Christian Meyer More articles by this author Nawar Hanna More articles by this author Adam Kibel More articles by this author Mani Menon More articles by this author Jesse Sammon More articles by this author Firas Abdollah 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 ...