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 useShow others and affiliations
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 Council2021-04-072021-04-072022-04-28Bibliographically approved