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Association between surgical volumes and real-world healthcare cost when using a mesh capturing device for pelvic organ prolapse: a 5-years comparison between single- versus multicenter use
Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden; Department of Gynecology & Obstetrics, Karolinska Institutet, Danderyd University Hospital, Danderyd, Stockholm, Sweden.
Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
Quantify Research, Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Quantify Research, Stockholm, Sweden.ORCID iD: 0000-0001-7241-8471
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2021 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 32, no 11, p. 3007-3015Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: The aim of this study was to evaluate whether high surgical volume at a single center was associated with lower healthcare costs compared to lower surgical volume in a multicenter setting.

Methods: All patients had symptomatic and anatomical apical prolapse (POP-Q ≥ stage II) with or without cystocele and were operated on by a standard surgical procedure using the Uphold mesh. Data on time of resource use in terms of surgery time, hospital stay and re-interventions across 5 years were compared between the single center (97 patients) and multicenter (173 patients, at 24 clinics). Unit costs for surgical time, inpatient and outpatient visits were extracted from the single-center hospital’s operation analysis program and prime production cost. Total costs were estimated for primary surgery and during 5-year follow-up.

Results: Costs for primary surgery were comparable between the single and the multicenter ($13,561 ± 2688 and $13,867 ± 1177, P = 0.29). Follow-up costs 5 years after primary surgery were 2.8 times higher at the multicenter than single center ($3262 vs. $1149, P < 0.001). Mean cost per patient over 5 years was significantly lower at the single than multicenter [$14,710 (CI: 14,168–15,252) vs. $17,128 (CI: 16,952–17,305), P < 0.001)].

Conclusions: Using a mesh kit for apical pelvic organ prolapse in a high surgical volume center was associated with reduced healthcare costs compared with a lower volume multiple-site setting. The cost reduction at the high surgical volume center increased over time because of lower surgical and medical re-intervention rates for postoperative complications and recurrence.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2021. Vol. 32, no 11, p. 3007-3015
Keywords [en]
Centralization, Health-care costs, Surgery volume, Vaginal prolapse mesh
National Category
Obstetrics, Gynecology and Reproductive Medicine Surgery
Identifiers
URN: urn:nbn:se:umu:diva-181531DOI: 10.1007/s00192-021-04698-xISI: 000622249200006PubMedID: 33635348Scopus ID: 2-s2.0-85101769947OAI: oai:DiVA.org:umu-181531DiVA, id: diva2:1542195
Funder
Swedish Research CouncilAvailable from: 2021-04-07 Created: 2021-04-07 Last updated: 2022-04-28Bibliographically approved

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Geale, Kirk

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