A. Reisman1, K. Farrell1, I. Leitman1 1Mount Sinai School Of Medicine,New York, NY, USA
Introduction: When evaluating the cost of a lifesaving procedure, it is also important to consider the relative value. One way to evaluate the economic value might be the relative cost of that procedure per additional year of life lived following. This evaluation might provide useful information for planning the application of these costly in-hospital procedures. The objective of this study was to determine the cost per year of life saved for the costliest complex elective surgical procedures performed at an urban academic medical center.
Methods: Total hospital charges were categorized by diagnosis related group (DRG) for patients discharged between January 1, 2015 and December 31, 2016. The average cost and patient age for each procedure were calculated. The average lifespan following successful outcomes for these procedures was determined based upon published benchmarks. Cost per year of life saved was calculated for each procedure. Emergent procedures and those done for chronic pain or interference with life style were excluded, leaving only those elective procedures necessary to prolong life.
Results: 114,448 hospital admissions were reviewed. The 12 most costly elective procedures were identified and ranked according to cost per year of life saved from lowest to highest: 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), craniotomy/intracranial 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 elective invasive procedures, coronary bypass surgery was the most economic. In addition to having the lowest cost per year of life saved ($1,345.45), coronary bypass surgery also had the longest post procedure life expectancy (17.6 years). These economic findings combined with further analysis of the identified procedures may allow us to better determine their relative value.
