Cost-containment Strategies Research Articles

Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy.

State employee health plans are consuming an ever-larger portion of state budgets because of rising health insurance premiums. Often the largest purchaser of commercial health insurance in their state, state employee health plans possess a unique opportunity to implement cost containment strategies. This study estimated potential savings from hospital payment caps among state employee health plans and the impact on commercial hospital operating margins. Using data from forty-six states and Washington, D.C., we estimated that payment caps set at 200percent of Medicare rates would have saved state employee plans an average of $150.2million per state in 2022 (0.35percent of state expenditures), leading to aggregate savings of $7.1billion nationally. Commercial hospital operating margins would remain healthy under this cap, falling from an average of 42.7percent to 41.7percent. Payment caps are a promising purchasing strategy for states to generate substantial reductions in health care spending.

Analyzing supply-side moral hazard behaviors in Botswana's health care market: A qualitative study

This paper aims to analyse the behaviours and practices of health care service providers that constitute supply-side abuse of the medical health insurance schemes premised on the notion that patients visit doctors precisely to learn what amount and type of care is medically necessary. Using qualitative methods, individual in-depth interviews were carried on private health service practitioners and thematic analysis via SPSS. The study identifies systemic abuses like overcharging, billing for services not provided, and over prescription. Implication of these findings show that Fee-for-Service Payment Models incentivize providers to deliver more services, leading to potential over-utilization and increased costs in Botswana’s healthcare; due to information asymmetry providers may prioritize quantity over quality of care exploiting patients’ lack of knowledge to recommend unnecessary tests or treatments to maximize on revenue but also costs. On how to minimize supply side moral hazards, the propositions is for pursuance of cost containment strategies to ensure the smooth operation of the schemes like price listings, educate beneficiaries on cost implications and sustainability threats. These propositions can be instituted through an industry led bench-marking, on nationally through regulatory frameworks since moral hazards are an economic cost as inefficiencies brings mis-allocation of resources to enhance the sustainability of medical aid-based health care provisioning.

Cheaper is not always better: Drug shortages in the United States and a value-based solution to alleviate them.

Drug shortages threaten patients' access to medications and are associated with adverse health outcomes and increased costs. Drug shortages disproportionately occur among generic drugs of limited profitability, most notably drugs administered by injection. In this perspective, we discuss how reimbursement and purchasing practices that were meant to create an efficient marketplace for generics have generated strong price pressure that threatens profitability in certain markets. We further explain how, faced with limited profitability, manufacturers lack incentives to invest in resilient supply chains, and in some cases, engage in cost-containment strategies or decide to exit the market, ultimately contributing to shortages. We propose the development and implementation of value-based reimbursement to provide needed incentives for drug purchasers and manufacturers to establish a more reliable supply chain as part of the policy solution to reduce the number and extent of drug shortages. This reimbursement model would necessitate the development of a rating system that measures supply chain resilience and maturity for each generic product. This rating would then be applied as a value-based modifier to reimbursement rates for generic products. The proposed model would result in higher reimbursement rates for generic products from more dependable supply chains, generating incentives for manufacturers to invest in supply chain resiliency. We propose the application of this reimbursement system originally in Medicare given Congressional interest on reforming Medicare payment to prevent drug shortages.

Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers

Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.

Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand.

Access to high-cost cancer drugs is an unsolved problem globally. The dedicated drugs fund is attractive and feasible. This study reviewed currently implemented dedicated drugs fund worldwide to inform policy implications for Thailand. A scoping review was conducted to identify countries currently implementing dedicated funds for cancer drugs. We searched electronic databases, PubMed and Embase, from 2010 to May 2021, Google and Google Scholar in August 2021, and government websites up to April 2022. The structure, management, cost containment strategies, and impact of dedicated funds were summarized and compared across the identified countries and Thailand. Out of 218 nations, Hong Kong, England, and Italy have established dedicated cancer drugs fund, primarily funded by their governments. Funds in England and Italy operate within annual budget limits. Hong Kong relies on an endowment fund. In England and Italy, pharmaceutical companies contribute proportionally to cover overspending as per risk-sharing agreements, while cost-sharing is not required. Hong Kong implements cost-sharing based on a patient's family income. England and Italy employ a parallel pathway, utilizing the same drug selection committee to determine whether innovative drugs belong in the regular pharmaceutical benefits package or the dedicated drugs fund. Hong Kong follows a sequential pathway, allowing drugs to be considered for the dedicated funds after a negative decision. These countries use the fund for 5-11 years, making administrative adjustments to ensure sustainability. The dedicated drugs fund is an effective strategy to improve access to non-reimbursable high-cost drugs in Thailand. Robust evaluation of the fund itself and funded drugs are recommended for policymakers' better decision-making. Learning from other countries can offer promising solutions. Health insurers need to balance providing cancer treatments with overall system preparedness.

Generic orphan drug substitution: a critical analysis of global practices and Saudi Arabia's perspective.

In an era of cost pressure, substituting generic drugs represents one of the main cost-containment strategies of healthcare systems. Despite the obvious financial benefits, in a minority of cases, substitution may require caution or even be contraindicated. In most jurisdictions, to obtain approval, the bioequivalence of generic products with the brand-name equivalent needs to be shown via bioavailability studies in healthy subjects. Rare diseases, defined as medical conditions with a low prevalence, are a group of heterogenous diseases that are typically severe, disabling, progressive, degenerative, and life-threatening or chronically debilitating, and disproportionally affect the very young and elderly. Despite these unique features of rare diseases, generic bioequivalence studies are typically carried out with single doses and exclude children or the elderly. Furthermore, the excipients and manufacturing processes for generic/biosimilar products can differ from the brand products which may affect the shelf-life of the product, its appearance, smell, taste, bioavailability, safety and potency. This may result in approval of generics/biosimilars which are not bioequivalent/comparable in their target population or that meet bioequivalence but not therapeutic equivalence criteria. Another concern relates to the interchangeability of generics and biosimilars which cannot be guaranteed due to the phenomenon of biocreep. This review summarizes potential concerns with generic substitution of orphan drugs and discusses potentially problematic cases including narrow therapeutic index drugs or critical conditions where therapeutic failure could lead to serious complications or even death. Finally, we put forward the need for refining regulatory frameworks, with emphasis on Saudi Arabia, for generic substitution and recent efforts toward this direction.

Changing Physician Behavior to be More Cost Conscious in Distal Radius Fracture Surgical Management: A Survey Study

Objectives:To evaluate six surgeons’ overall experience using cost-effective implants compared to the implants they typically use.Design:Cross-sectional SurveySetting:A Metropolitan Healthcare SystemParticipants:Six surgeons who operatively treat distal radius fractures regularly.Intervention:Surgeons were asked to alternate implant (brand name vs. generic) use in DRF fixation each month. They were then sent a 10-question survey to evaluate their experience with the generic implants. Most questions were rated on a 1-10 Likert scale (1=worst outcome, 10=best outcome). Main Outcome Measurements:Ease of Use and Continued Generic Implant UseResults:All six surgeons completed the survey (100% response rate). Most surgeons completed a hand surgery fellowship (83.3%) and performed their cases in an ambulatory surgery center (83.3%). The average rating for ease of use and how intuitive the system was were 8.8±2.2 and 8.5±1.7. Most surgeons felt that generic implants added little or no extra time to the procedure (4.5±1.0, with 5 being neutral). Most in this group would use generic implants again and recommend them to colleagues (8.2±2.9, 8.0±3.2, respectively).Conclusions:Implant preference is often driven by exposure during residency and fellowship and is minimally evidence-based by comparison. In many instances there is a belief that the value lies in the technology when, in fact, patient selection, surgical technique and post-operative management are more important in determining patient outcome. As cost containment strategies are developed and implemented, we recommend they come from physician leadership, and not top-down administrative mandates.Key Words:Surgeon Behavior, Satisfaction Survey, Implant Cost, Cost Containment Strategy, Generic Implants, Distal Radius FractureLevel of Evidence:Level V

Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement

BackgroundTotal knee arthroplasty (TKA) is commonly considered to address symptomatically limiting knee osteoarthritis. With increasing utilization, understanding the variability and related drivers may help the healthcare system optimize delivery to the large numbers of patient to whom it is offered. MethodsA total of 1,066,327 TKA patients who underwent primary TKA were isolated from a 2010 to 2021 PearlDiver national dataset. Exclusion criteria included patients less than 18 years old and traumatic, infectious, or oncologic indications. Overall, 90-day reimbursements and variables associated with the patient, surgical procedure, region, and perioperative period were abstracted. Multivariable linear regressions were performed to determine independent drivers of reimbursement. ResultsThe 90-day postoperative reimbursements had an average (standard deviation) of $11,212.99 ($15,000.62), a median (interquartile range) of $4,472.00 ($13,101.00), and a total of $11,946,962,912. Variables independently associated with the greatest increase in overall 90-day reimbursement were related to admission (in-patient index-procedure [+$5,695.26] or hospital readmission [+$18,495.03]). Further drivers were region (Midwest +$8,826.21, West +$4,578.55, South +$3,709.40; relative to Northeast), insurance (commercial +$4,492.34, Medicaid +$1,187.65; relative to Medicare), postoperative emergency department visits (+$3,574.57), postoperative adverse events (+$1,309.35), (P < .0001 for each). ConclusionThe current study assessed over a million TKA patients and found large variations in reimbursement/cost. The largest increases in reimbursement were associated with admission (readmission or index procedure). This was followed by region, insurance, and other postoperative events. These results underscore the necessity to balance performing out-patient surgeries in appropriate patients versus the risk of readmissions and defined other areas for cost containment strategies.

Assessment of Fast-Track Pathway in Hip and Knee Replacement Surgery by Propensity Score Matching on Patient-Reported Outcomes.

Total hip (THA) and total knee (TKA) arthroplasty procedures have steadily increased over the past few decades, and their use is expected to grow further, mainly due to an increasing number of elderly patients. Cost-containment strategies, supporting a rapid recovery with a positive functional outcomes, high patient satisfaction, and enhanced patient reported outcomes, are needed. A Fast Track surgical procedure (FT) is a coordinated perioperative approach aimed at expediting early mobilization and recovery following surgery and, accordingly, shortening the length of hospital stay (LOS), convalescence and costs. In this view, rapid rehabilitation surgery optimizes traditional rehabilitation methods by integrating evidence-based practices into the procedure. The aim of the present study was to compare the effectiveness of Fast Track versus Care-as-Usual surgical procedures and pathways (including rehabilitation) on a mid-term patient-reported outcome (PROs), the SF12 (with regard both to Physical and Mental Scores), 3 months after hip or knee replacement surgery, with the use of Propensity score-matching (PSM) analysis to address the issue of the comparability of the groups in a non-randomized study. We were interested in the evaluation of the entire pathways, including the postoperative rehabilitation stage, therefore, we only used early home discharge as a surrogate to differentiate between the Fast Track and Care-as-Usual rehabilitation pathways. Our study shows that the entire Fast Track pathway, which includes the post-operative rehabilitation stage, has a significantly positive impact on physical health-related status (SF12 Physical Scores), as perceived by patients 3 months after hip or knee replacement surgery, as opposed to the standardized program, both in terms of the PROs score and the relative improvements observed, as compared with the minimum clinically important difference. This result encourages additional research into the effects of Fast Track rehabilitation on the entire process of care for patients undergoing hip or knee arthroplasty, focusing only on patient-reported outcomes.

Implementation of lean thinking in healthcare services: Why is it importance

Background: : Indonesia has implemented National Health Insurance since 2014 through quality improvement and cost efficiency strategy. In the early implementation, many hospitals suffered a loss due to the absence of efficiency in operational health services. In the other hand, few hospitals have implemented lean as an attempt of quality improvement and cost efficiency in National Health Insurance era. There is not enough evidence in Indonesia to support management tools implementation such as Lean for improving efficiency. Aims: This study aims to develop scientific knowledge and goodwill of Lean implementation in healthcare services in many countries. This study also becomes evidence-based to implement lean in Indonesia. Methods: This study used a systematic literature review and searched PubMed, Scopus, Clinical key, Sciencedirect, EBSCO, and other related journals from 2009 to 2018 with syntax keywords for each database. Twenty-two articles were included in the reviewed. Results: The result showed that most journals discussed Lean reducing lead time and ALOS to improve the patient value and patient safety, as well as the amount of journal discussed about Lean made cost reduction in healthcare operational to improve efficiency. Conclusion: Lean implementation should be adopted by Indonesian hospitals as quality improvement and cost containment strategy and enhance patient safety under National Health Insurance era.

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study.

To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy. Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien-Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model. 135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9-53,532.5) and $81,050.1 (49,614.8-122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%-76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%-181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08-1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23-5.07) respectively. These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

Implementation of cost containment strategy in pharmacy: A literature review

Implementation of cost containment strategy in pharmacy: A literature review

Value Challenge: A Bottoms-Up Approach to Minimizing Cost and Waste in Orthopaedic Surgery.

Orthopaedic surgical residents from an academic program with a Level I trauma center were queried during 2019 to 2022 regarding suggestions for cost containment opportunities. Based on feasibility and the estimated impact, 7 responses were selected to undergo cost-saving analyses. The proposed initiatives fell into 2 categories: minimizing waste and optimizing patient care. Eliminating nonessential physical therapy/occupational therapy consults led to the greatest estimated savings ($8.6M charges/year), followed by conserving reusable drill bits ($2.2M/year) and reducing computed tomography scans on lower extremity injuries ($446K/year). Current medical training provides limited formal education on cost-effective care. Efforts to mitigate the growing financial and environmental costs of health care should include encouraging and incorporating resident feedback into cost reduction strategies. This tactic will likely have a positive impact on the behavior of such resident surgeons as they enter practice and have more awareness of costs and value. V (cost-minimization study).

EXPERIENCE OF PROFESSIONAL US PHARMACIST TRAINING IN ORGANIZATIONAL AND MANAGEMENT ACTIVITIES IN THE INDUSTRY

The study has analyzed a set of sources of foreign experience in pharmacy specialist training. It has been determined that employees of the pharmaceutical industry must have management and organizational skills to manage personnel and production, the sale of medicinal products in a broad sense of this concept and depending on the specifics of the industry. American scientists pay special attention to the formation of compassion and the ability to maximize patient safety in pharmacists (E. Scott); focus attention on the need for moral education in pharmaceutical educational institutions (D. Latif); develop cultural qualities of pharmaceutical workers as the ability to service-oriented partnership while considering the development of communicative qualities, tact, benevolence towards the customers of the pharmacy as crucial (D. Rodiz). Practicing teachers in the USA supported the position regarding the formation of professional culture and its deontological component in the process of teaching the disciplines «Pharmaceutical law and ethics», «Personal care and elementary medicine», «Pharmaceutical management», etc. It has been found that the existing educational programs of pharmaceutical faculties in the USA are deeply oriented towards mastering organizational and administrative skills by future specialists; it enables rapid retraining and response to dynamic changes in market conditions. Emphasis is placed on the need for additional graduate education preceded by formal degree programs for American pharmaceutical managers.&#x0D; It has been established that in the curriculum of pharmacy specialists in the USA, there are the following disciplines: pharmaceutical management, ethics of pharmaceutical activity, interpersonal communications of healthcare professionals, pharmaceutical legislation, and economics. While mastering the specialty of professional practical management (Professional Practice Management), pharmacy specialists study financial management, pharmacoeconomics, cost containment strategies, labor resource management, and the choice of specialization in one of the directions of pharmaceutical management (public pharmacy, entrepreneurship, drug production research, pharmaceutical supply management). It gives reason to conclude attention to the formation of the pharmacists&amp;apos; organizational and management culture. From the perspective of research activity on the issue, the specification of the theoretical foundations and detailing methodological aspects of the American experience implementation of training specialists are outlined.

Healthcare cost consciousness among physicians and their attitudes towards controlling costs in Jordan: a cross sectional study

BackgroundOne of the most significant factors influencing medication adherence and, ultimately, therapeutic outcomes for patients is the cost. The aim of this study was to examine the cost-containment strategies used by physicians in Jordan while focusing on the importance of cost consciousness in addressing healthcare costs and its consequences.MethodA quantitative study was conducted between June 19 and November 15, 2021, through a cross-sectional survey using a self-administered questionnaire.ResultsA total of 389 physicians participated in this study. Governments (65.6%), health insurance companies (60.2%), and pharmaceutical and device manufacturers (57.9%) were the most frequently mentioned entities as being primarily responsible for reducing healthcare costs. Participating physicians showed a high level of enthusiasm towards all domains of reducing healthcare costs with a mean percentage of 88.3% (standard deviation (SD): 0.04). When discussing physicians’ roles in containing healthcare costs and the effects of cost-conscious practice, most respondents agreed that there is currently too much emphasis on test and procedure costs (83.0%), that decision support tools that show costs would be helpful in their practice (84.5%), and that physicians need to take a more prominent role in limiting the use of unnecessary tests (86.0%). Around 70.0% of physicians agreed that they requested more tests when they did not know the patient well, and 80.0% of them stated that they considered the uncertainty involved in patient care to be disconcerting.ConclusionParticipating physicians showed a moderate level of cost consciousness in Jordan. However, this must be higher because it will eventually lead to cost-related nonadherence, which will have a negative impact on the patient’s health.

Cost-containment long-term care policies for older people across the Organisation for Economic Co-operation and Development (OECD): a scoping review

Abstract In most Organisation for Economic Co-operation and Development (OECD) countries, the government has to manage tension between growth in the need for long-term care (LTC) services for older people and significant public budget constraints. Not surprisingly, therefore, cost-containment policies are of increasing relevance. Nevertheless, despite the flourishing interest in the comparative literature in reforms and the sustainability of LTC policies, a scoping review of these measures has so far not been produced. This article aims to contribute to filling this gap. We present a typology of LTC cost-containment policies across the OECD. Cost-containment policies cluster in two areas according to their focus: demand-side policies, which reduce the actual chances of receiving LTC services and/or make them more expensive for users; and supply-side ones, which modify the provision of services. Furthermore, an indirect outcome of the review is that it allows an overview of potential negative implications of these policies. These negative implications can be grouped in two macro spheres relating to a worsening of the care arrangements for beneficiaries and to increased demand for individual/family resources, in both economic and time and effort terms. In the light of the expected profound impacts of the COVID-19 outbreak on all social security sectors in the medium and long term, this article provides a valuable tool for both academic and policy-making debate. It allows an analytical comprehension of cost-containment strategies adopted in LTC sectors linking them with the related impacts on beneficiaries and their families.

Bioequivalence, Drugs with Narrow Therapeutic Index and The Phenomenon of Biocreep: A Critical Analysis of the System for Generic Substitution.

The prescription of generic drugs represents one of the main cost-containment strategies of health systems, aimed at reducing pharmaceutical expenditure. In this context, most regulatory authorities encourage or obligate dispensing generic drugs because they are far less expensive than their brand-name alternatives. However, drug substitution can be critical in particular situations, such as the use of drugs with a narrow therapeutic index (NTI). Moreover, generics cannot automatically be considered bioequivalent with each other due to the biocreep phenomenon. In Italy, the regulatory authority has established the Transparency Lists which include the medications that will be automatically substituted for brand-name drugs, except in exceptional cases. This is a useful tool to guide prescribers and guarantee pharmaceutical sustainability, but it does not consider the biocreep phenomenon.

Basel III Capital Regulations and Bank Efficiency: Evidence from Selected African Countries

The core function of a commercial bank is the provision of credit facilities to its customers and to keep the flow and cycle of economic and financial resources balanced. Banks can only perform these functions if they are well regulated and efficient. The main focus of this study is to analyse the efficiency of African banks, most importantly after the 2008 global financial crisis when the Basel III regulations were popularly adopted by banks globally. The research focus was examined in two ways, the first part focused on investigating the impact of the Basel III capital regulations on the operational and investment efficiency of African banks by using the random effects and pooled ordinary least square panel data regression models. The second part examined if the African banks are indeed efficient by analysing their level of efficiency using the input-oriented DEA approach. The study used audited bank-level data from 45 listed banks operating in six African nations, namely, South Africa, Nigeria, Kenya, Tanzania, Uganda and Malawi, that have adopted the Basel III Accord for the period from 2010 to 2019. The bank-level data were obtained from the IRESS database. The findings revealed that capital buffer premiums significantly affect the operating and investment efficiency of African banks positively. This relationship implies that the capital buffer premium does not only serve as cushion capital against financial, market and economic shocks but also improves the banks’ efficiency by influencing the banks’ decisions and perspective on cost containment strategies. Another key finding is the positive influence the liquidity coverage ratio has on banks’ operational efficiency. The implication of this relationship may simply mean that African banks with well-performing liquidity ratios are efficient in their operations with the ability to meet their short-term obligations such as meeting customers’ credit needs, unannounced depositors’ withdrawals and creditors’ repayments, amongst others. This result could well be interpreted that adopting stricter liquidity requirements creates a liquidity buffer for African banks, giving them cushion confidence to undertake profitable and high-yielding projects, which invariably lead to increased profitability and operational efficiency. Furthermore, the DEA results showed that the sampled banks are operationally efficient with an aggregate of 84.8%, and for their investment efficiency, an aggregate of 94.9%. These findings suggest that African banks are largely efficient and can survive any possible financial or economic crisis. It can be put forward that it is probable that banks that are yet to adopt the Basel III Accord or strengthen their capital and liquidity base, are less efficient and might fail during a global crisis. The current work suggests some appropriate policy-based recommendations.

Long term cost comparisons of radical cystectomy versus trimodal therapy for muscle-invasive bladder cancer.

Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term costs of care. We determined the 2- and 5-year costs associated with trimodal therapy (TMT) vs. radical cystectomy (RC). We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Total Medicare costs at 2 and 5 years following RC vs. TMT were compared using inverse probability of treatment-weighted propensity score models. A total of 2,537 patients aged 66 to 85 years were diagnosed with clinical stage T2-4a muscle-invasive bladder cancer. Total median costs for patients that received no definitive treatment(s) were $73,780 and $88,275 at 2-and 5-years. Costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, Median Difference $127,815, Hodges-Lehmann Estimate (H-L) 95% Confidence Interval (CI), $112,663-$142,966) and 5-years ($424,570 vs. $253,651, Median Difference $124,466, H-L 95% CI, $105,711-$143,221). TMT had higher outpatient costs than RC (2-years: $318,221 vs. $100,900; 5-years: $367,092 vs. $146,561) with significantly higher costs with radiology, medications, pathology/laboratory, and other professional services. RC had higher inpatient costs than TMT (2-years: $62,240 vs. $33,631, Median Difference $-29,174, H-L 95% CI, $-32,364-$-25,984; 5-years: $75,499 vs. $45,223, Median Difference $-29,843, H-L 95% CI, $-33,905-$-25,781). The excess spending associated with trimodal therapy vs. radical cystectomy was largely driven by outpatient expenditures. The relatively high long-term trimodal therapy costs are prime targets for cost containment strategies to optimize future value-based care.

The Association of Postoperative Complications and Hospital Costs Following Distal Pancreatectomy.

BackgroundUnderstanding the financial implications associated with the complications post-distal pancreatectomy (DP) may be beneficial for the future optimisation of postoperative care pathways and improved cost-efficiency. The primary outcome of this retrospective study was the characterisation of the additional cost associated with postoperative complications following DP. The secondary outcome was the estimation of the prevalence, type and severity of complications post-DP and the determination of which complications were associated with higher costs.MethodsPostoperative complications were retrospectively examined for 62 adult patients undergoing distal pancreatectomy at an Australian university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo (CVD) classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology and was reported in US dollars at 2021 rates. Regression modelling was used to investigate the relationships among selected perioperative variables, complications and costs.Results45 patients (72.6%) experienced one or more postoperative complications. The median (IQR) hospital cost in US dollars was 31.6% greater in patients who experienced complications compared to those who experienced no complications ($40,717.8 [27,358.0–59,834.3] vs. $30,946.9 [23,910.8–46,828.1]). Costs for patients with four or more complications were 43.5% higher than for those with three or fewer complications (p = 0.015). Compared to patients with no complications, the median hospital costs increased by 17.1% in patients with minor complications (CVD grade I/II) and by 252% in patients who developed major complication (i.e., CVD grade III/IV) complications.ConclusionPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following distal pancreatectomy with number and severity of postoperative complications being associated with increased hospital costs. (Registered in the Australian New Zealand Clinical Trials Registry [No. ACTRN12622000202763]).