Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability

Our plain-English summary of Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability, by P.F. Bagnoli, F.C. Cananzi, A. Brocchi, et al (European Journal of Surgical Oncology, 2015).

The study

• Authors: P.F. Bagnoli, F.C. Cananzi, A. Brocchi, A. Ardito, D. Strada, L. Cozzaglio, C. Mussi, S. Brusa, C. Carlino, B. Borrelli, F. Alemanno, V. Quagliuolo
• Journal: European Journal of Surgical Oncology
• Published: 2015;41(3):386-91
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignancies of the peritoneum remain a challenge in any hospital that accepts to manage them, due not only to difficulties associated with the complexity of the procedures involved but also the costs, which - in Italy and other countries that use a diagnosis-related group (DRG) system - are not adequately reimbursed.

Material And Methods: We analyzed data relative to 24 patients operated on between September 2010 and May 2013 with special regard to operating room expenditure, ICU stay, duration of hospitalization, and DRG reimbursement. The total costs per patient included clinical, operating room, procedure, pathology, imaging, ward care, allied healthcare, pharmaceutical, and ICU costs.

Results: Postoperative hospital stay, drugs and materials, and operating room occupancy were the main factors affecting the expenditure for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We had a median hospitalization of 14 days, median ICU stay of 2.4 days, and median operating room occupancy of 585 min. The median expenditure for each case was € 21,744; the median reimbursement by the national health system € 8,375.

Conclusions: In a DRG reimbursement system, the economic effort in the management of patients undergoing peritonectomy procedures may not be counterbalanced by adequate reimbursement. Joint efforts between medical and administration parties are mandatory to develop appropriate treatment protocols and keep down the costs.

Copyright © 2014 Elsevier Ltd. All rights reserved.

In plain English

This was a cost analysis from one hospital in Rozzano, Italy. It looked at surgery to remove tumor from the abdominal lining (peritonectomy), followed by heated chemotherapy in the abdomen (HIPEC). The study did not examine asbestos exposure. The authors reviewed costs for 24 patients operated on between September 2010 and May 2013. Only 2 had malignant mesothelioma. The others had ovarian cancer (9), pseudomyxoma peritonei (7) or colorectal cancer (6). The median cost per patient was €21,744, and the median payment from the Italian national health system was €8,375. Across all 24 cases, costs of €521,844 exceeded reimbursement by €320,851. The main cost drivers were the hospital stay after surgery, drugs and materials, and operating room time. Complications occurred in 54.2% of patients, and no patient died after surgery. The authors concluded that Italy's diagnosis-related group payments did not cover the costs, and that careful savings might partly make up the gap. They noted that the group was small and highly selected, and that the costs were specific to their hospital and region.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-hospital cost analysis of patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC)
• Who was studied: 24 patients with peritoneal surface malignancies (18 women, 6 men) operated on at Humanitas Clinical and Research Center, Rozzano, Italy, between September 2010 and May 2013
• Exposure: No asbestos exposure was studied. The subject was the hospital cost of CRS + HIPEC treatment.
• Main results:
  • Of the 24 patients, 9 had epithelial ovarian cancer (EOC), 7 pseudomyxoma peritonei (PMP), 6 colorectal cancer (CRC) and 2 malignant mesothelioma (MM)
  • Per patient: median cost €21,744; median reimbursement from the national health system €8,375
  • For all 24 cases: overall costs were €521,844, given as 259.6% of total reimbursement. The gross profit margin was minus €320,851 (minus 159.6%). Total reimbursement is printed as 'V 200.993'.
  • Postoperative hospital stay, drugs and materials, and operating room occupancy were the main cost factors
  • Median hospitalization 14 days, median ICU stay 2.4 days, median operating room occupancy 585 minutes
  • Morbidity (complication) rate was 54.2%, with no postoperative deaths
• The authors' conclusion: The authors concluded that in a DRG reimbursement system the cost of these procedures may not be balanced by adequate reimbursement. They believed an appropriate savings policy may partly make up for this until the DRG system is revised.
• Limitations the authors state:
  • Small number of patients, making definitive conclusions difficult
  • Patients were highly selected and had a moderate median Peritoneal Cancer Index
  • Costs and reimbursements were specific to this hospital and regional healthcare system, so the results may not be widely applicable
  • Mean cost may be an oversimple criterion; a cost-effectiveness analysis was not done

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: HIPEC, Peritoneum, Pathology, Cytoreductive Surgery.

Related studies

• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking — S. Riss, K. Chandrakumaran, et al. (2015)

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