Abstract
Introduction: When evaluating the cost of a lifesaving operation, one must consider the economic value, which can be defined as the relative cost per additional year of life lived. This evaluation might provide useful information for the application of costly procedures. The objective of this study was to determine the cost per year of life saved for the costliest operations performed at an urban academic medical center. Methods: Total hospital expenditures were categorized by diagnosis related group (DRG) between January 1, 2015 and December 31, 2016. Average cost and patient age for each procedure were calculated. Average lifespan following successful outcome was determined based upon published benchmarks. Cost per year of life saved was calculated for each procedure. Only those elective procedures necessary to prolong life and enhance health were analyzed. Results: 114,448 hospital admissions were reviewed. The 12 costliest procedures were identified and ranked according to cost per year of life saved: Coronary bypass ($1,345.45), portacaval shunt procedure ($2,261.70), cardiac valve/other major cardiothoracic procedure ($2,733.78), major bladder procedure ($2,733.78), cardiac defibrillator implant ($5,047.65), bone marrow transplant ($5,181.80), intracranial vascular procedures ($8,572.05), kidney transplant ($9,024.87), liver transplant ($11,112.73), endovascular cardiac valve replacement ($12,842.25), simultaneous pancreas/kidney transplant ($14,087.50), and heart transplant ($20,472.11). Conclusion: Among the costliest procedures, coronary bypass was the most economic, having the lowest cost per year of life saved ($1,345.45) and longest post-procedure life expectancy (17.6 years). These findings combined with further analysis of the identified procedures may allow us to better determine their relative value.
Highlights
When evaluating the cost of a lifesaving operation, one must consider the economic value, which can be defined as the relative cost per additional year of life lived
The hospital’s most inexpensive lifesaving surgical procedures were ranked from most economically valuable to least economically valuable based on their respective cost per year of life saved (Table 3 and Figure 1), which ranged from $92.14 to $267.29 (Figures 2 and 3). This retrospective economic study has identified the relative cost per additional year of life lived following some of the most expensive lifesaving procedures performed at an academic medical center
As value analysis is not a perfect science, this assessment evaluated each procedure in terms of two metrics – the cost per year of life saved and the cost per quality adjusted life-year (QALY) saved, neither of which account for reductions in morbidity
Summary
When evaluating the cost of a lifesaving operation, one must consider the economic value, which can be defined as the relative cost per additional year of life lived. This evaluation might provide useful information for the application of costly procedures. Conclusion: Among the costliest procedures, coronary bypass was the most economic, having the lowest cost per year of life saved ($1,345.45) and longest post-procedure life expectancy (17.6 years). These findings combined with further analysis of the identified procedures may allow us to better determine their relative value. The burden of surgically treatable disease within developing countries has grown substantially and requires an evaluation of a wide range of surgical interventions to determine their capacity to improve global health [4]
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