Costs and effectiveness of appendectomy in sonla province general hospital

Nội dung text: Costs and effectiveness of appendectomy in sonla province general hospital

1. Journal of military pharmaco-medicine n 08-2017 COSTS AND EFFECTIVENESS OF APPENDECTOMY IN SONLA PROVINCE GENERAL HOSPITAL Nguyen Duc Toan*; Pham Le Tuan** SUMMARY Objectives: To assess impact of costs and efficiency of appendectomy in Sonla Province General Hospital. Subjects and methods: The research was conducted on 322 patients who underwent laparoscopic appendectomy and open appendectomy at Sonla Province General Hospital from 01 - 01 - 2012 to 30 - 12 - 2013. Sample selection error is controlled by Propensity Score Matching (n = 109 pairs). Results and conclusions: The hospital stay in the group of laparoscopic appendectomy (4.2 ± 2.3 days) was less than that of open appendectomy (5.2 ± 2.2 days), but the difference did not have statistical significance (p > 0.05). The cost of open appendectomy and laparoscopic appendectomy in cases with complications (5,918.7 thousand and 5,247.9 thousand VND) was higher than the group without complications (5,531.9 thousand and 5,126.3 thousand). The cost of treatment of open appendectomy was higher than that of laparoscopic appendectomy, yet the effectiveness of laparoscopic appendectomy (96.3%) was higher than that of open appendectomy (93.6%), (p > 0.05). Therefore, laparoscopic appendectomy is the best choice for the patients with acute appendicitis. * Keywords: Appendicitis; Laparoscopic appendectomy; Cost. INTRODUCTION and its complication rate was lower (LA: 9% compared with open surgery: 17%). Health economic evaluation is a systematic approach designed to offer the policy Incision infection rate was also lower makers a wide variety of options. Cost, (1% vs. 3%). Obese patients treated with effectiveness analysis is a form of LA had higher complication rate (27% cost-benefit analysis. Analysis of cost versus 18%) and the treatment cost was effectiveness has helped choose more also higher (16,600 dollars compared to effective methods at the same cost or 12,300 dollars). Lin K.B et al (2015) [7] equally effective ones at a lower cost [1, 2]. revealed that low income patients benefit The cost - efficiency laparoscopic more from LA than OA due to reduced appendectomy (LA) and open appendectomy hospitalization time, fewer complications (OA) was one of many authors’ interest and fewer hospitalization for treatment of [3, 4, 5, 6]. The study by Varela J.E et al. complications. Therefore, this study was (2008) [8] on 1,943 patients showed that conducted: To assess the impact of costs the hospital stay of LA group was shorter and efficiency of appendectomy in Sonla than that of OA (3 days compared to 4 days) Province General Hospital. * Sonla Province General Hospital * Department of Health Corresponding author: Nguyen Duc Toan (nguyenductn29@gmail.com) Date received: 21/08/2017 Date accepted: 29/09/2017 166
2. Journal of military pharmaco-medicine n 08-2017 SUBJECTS AND RESEARCH Five prognosis factors are put into pair METHODS according to PSM method are age, time 1. Subjects. from sickness until the surgery, time of OA and LA surgery patients were enrolled hospital admission, the progression of in Sonla Province General Hospital from acute appendicitis and who pays the 01 - 01 - 2012 to 30 - 12 - 2013. costs. 2. Method. - Tools, indicators and variables studied: patients interview about direct costs outside - Sample size: All patients were adults who underwent OA and LA surgery in Sonla health, indirect costs of households based Province General Hospital from 01 - 01 - on sets of questions are available after 2012 to 30 - 1 - 2013. training. - Research design: Descriptive horizontal - The data is handled by the method of slicing analysis. biological-medical statistics using IBM + On the basis of factors related to SPSS 22.0 software. Descriptive statistics prognosis of cost-effectiveness of OA and with X ± SD. Differences are statistically LA, to control the model selecting errors significant when p < 0.05 and highly we applied Propensity Score Matching (PSM). significant when p < 0.001. RESULTS Table 1 : The length of hospital stays of patients with acute appendicitis. Time (days) OA (n = 109) (1) LA (n = 109) (2) p1-2 The number of patients 93 97 No complications (A) X ± SD 5.1 ± 2.1 4.2 ± 2.4 > 0.05 The number of patients 16 12 With complications (B) X ± SD 6.0 ± 2.8 3.9 ± 0.9 < 0.01 pA-B > 0.05 > 0.05 The total number 5.2 ± 2.2 4.2 ± 2.3 > 0.05 Table 1 shows the hospital stay of LA was less than OA, but the difference did not have statistical significance (p > 0.05). For the group of acute appendicitis with complication, time of hospitalization of LA was less than that of OA, the differences are statistically significant (p < 0.01). 167
3. Journal of military pharmaco-medicine n 08-2017 Table 2: Cost of surgery for complicated acute appendicitis and uncomplicated cases. (Unit: thousand VND) Complications of acute appendicitis OA (n = 109) LA (n = 109) p1-2 X ± SD 4,163.0 ± 2,749.0 3,965.0 ± 1,916.0 > 0.05 (A) Median 3,686.6 4,352.2 The cost paid to the hospital X ± SD 4,259.7 ± 2,375.4 3,904.6 ± 1,478.1 > 0.05 Yes (B) Median 3,326.4 4,209.0 pA-B > 0.05 > 0.05 X ± SD 422.4 801.6 671.1 ± 388.0 > 0.05 (A) Median 740.0 600.0 Direct costs in addition to X ± SD 980.9 ± 382.0 705.8 ± 438.3 > 0.05 healthcare Yes (B) Median 970.0 535.0 pA-B > 0.05 > 0.05 X ± SD 567.3 ± 770.0 490.1 ± 593.5 > 0.05 (A) Median 350.0 400.0 Indirect costs X ± SD 678.1 ± 926.2 637.5 ± 470.0 > 0.05 Yes (B) Median 425.0 775.0 pA-B > 0.05 > 0.05 X ± SD 5,531.9 ± 3,042.3 5,126.3 ± 2,465.8 > 0.05 (A) Median 4,806.9 5,404.6 Total X ± SD 5,918.7 ± 2,966.0 5,247.9 ± 1,382.1 < 0.05 Yes (B) Median 4,980.9 5,462.8 pA-B > 0.05 < 0.05 (* Acute appendicitis with complications (OA: 16; LA: 12) Table 2 shows the total costs of OA in the group of appendicitis with complication was higher than that of LA group, the differences were statistically significant with p < 0.05. In both groups, the total costs of the group of acute appendicitis with complications was higher than the group without complication, the differences were statistically significant (p < 0.05). 168
4. Journal of military pharmaco-medicine n 08-2017 Table 3: Cost of surgery for acute appendicitis according to the results of surgery. (Unit: thousand VND) Results of surgery OA (n = 109) (1) LA (n = 109) (2) p1-2 n (efficiency) 102 (93.6%) 105 (96.3%) X ± SD (costs) 5,623.1 ± 3,071.6 5,037.8 ± 2,157.2 > 0.05 Good (A) Median 4,850.0 5,404.6 (QL25-QL75) [3,759.1 - 6,775.9] [2,938.9 - 6,325.6] n (efficiency) 7 (6.4%) 4 (3.7%) X ± SD (costs) 5,087.6 ± 2,262.0 7,814.3 ± 5,513.6 < 0.05 Average (B) Median 4,264.4 5,508.3 (QL25-QL75) [3,652.6 - 5,294.8] [4,342 8-13.592, 0] pA-B > 0.05 < 0.001 n 109 109 The total cost X ± SD 5,588.7 ± 0 3.02 5,139.6 ± 2,366.6 < 0.05 Median 4,833.9 5,404.6 We found that in the group with good surgical results, OA was more costly than LA, but the differences were not statistically significant (p > 0.05). In the group of average surgery results, the total cost of LA was greater than that of OA, the differences were statistically significant (p < 0.05). DISCUSSION hospital cost of 61 households where children with acute appendicitis were operated 1. Cost impact. promptly and unpromptly leading to appendicitis In the OA group, total cost of the group perforation. Perforated patients had longer of acute appendicitis with complication hospital stay (9 days) than the group of was VND 386.8 thousand higher than that of the group without complication. For LA early surgery (7 days), (p = 0.02) and the patients, the total cost of acute appendicitis total cost of the hospital stay was also with complication was VND 121.6 thousand, significantly larger ($31.349 compared to higher than the group without complication, $21.323, p = 0.01). No significant difference the differences were statistically significant was seen in the number of school holidays (p < 0.05). Therefore, for complicated (9 days compared to 10 days, p = 0.23) and cases of acute appendicitis, LA as well as OA adult holiday time for care (5 days versus had higher expenditure compared to group 7 days, p = 0.18). The authors said that the of uncomplicated acute appendicitis. hospital stay in the group of acute This result was similar to other authors’. appendicitis and perforation was longer Dennett K.V et al (2012) [3] made a with more costs, but indirect costs were comparison between direct and indirect not higher than those were treated early. 169
5. Journal of military pharmaco-medicine n 08-2017 Research by Cárdenas-Salomon C.M medical costs are mainly the cost of et al (2011) [1] showed hospitalization medicine and nursing costs. time of OA group was higher than that of LA 2. Cost impact based on efficiency. (3.33 compared to 2.52 days, p < 0.0001). Research results showed that the hospital The treatment cost of LA group was 25% stay in LA group (4.2 ± 2.3 days) was less higher than open surgery (p = 0.0005). than OA (5.2 ± 2.2 days), but the difference The cost of LA without complication was did not have statistical significance (p > 0.05). 1.7 times higher compared to open surgery In the surgery group with good results, the (p < 0.0001). There was no difference in total cost of OA (5,623.1 ± 3,071.6 thousand) terms of the cost of hospitalization and was higher than that of LA (5,037.8 ± surgery between groups with complications 2,157.2 thousand) but not statistically (p = 0.5319). significant (p > 0.05). In the surgery group with median results, the total cost of LA Dhupar R et al (2012) [4] carried out (7,814.3 ± 5,513.6 thousand) was higher the study on 453 patients with than that of OA (5,087.6 ± 2,262.0 thousand), appendectomy found that patients with the differences were statistically significant complication had hospital stays as much with p < 0.05. as 2.3 times compared to the group Based on the two criteria of cost and without complications (4.4 days versus efficacy of LA and OA, we found that OA 1.9 days; p < 0.001) and the average cost was more costly than LA, yet LA was was as high as 86% ($14.125 versus more effective. The cost-effectiveness $7.595; p < 0.001). The differences in table was illustrated as below: Table 4: Cost-effectiveness of LA and OA. Cutting performance The cost of the CRT appendix NS NS MM < NS 1: Increased cost- 4: NS better than MM 7: NS better than MM effectiveness ratio MM = NS 2: MM better than NS 5: Consider other factors 8: NS better than MM MM > NS 3: MM better than NS 6: MM better than NS 9: Increased cost- effectiveness ratio We can see that LA outweighs OA. This is also similar to foreign authors’ research findings. Dubois L et al (2010) [5] carried out study on 161 LA patients, the author found that the proportion of patients treated early was 45% (72/161 patients) with mean surgery time of 4.7 hours. The group of patients treated early had similar complication rate to other groups (4.3% versus 7.1%), but the time of hospital stay in the recovery room after surgery significantly reduced (4.7 hours compared with 16.2 hours, p < 0.001), the average cost for a patient decreased $323.46. The authors said that if patients, who were discharged from hospital soon after LA, the treatment cost would be reduced 45% of hospital bed demand, so we may save about 300 dollars per patient. 170
6. Journal of military pharmaco-medicine n 08-2017 According to Khan S.Y et al (2013) [6], REFERENCES mean cost of LA (534 Oman riyal) was higher than that of open surgery (343 Oman 1. Cárdenas-Salomon C.M, Cervantes-Castro, riyal) (p < 0.001). The authors suggested j. j.-S.E.R et al. Hospitalization costs of that cost of LA was more expensive than open vs. laparoscopic appendectomy: 5-year experience. CIR Cir. 2011, 79 (6), pp.534-539. open surgery, but similarly safe and does not increase the rate of complications 2. Costa-Navarro d, Jiménez-Fuertes m and or time of hospital stay. Costa-Navarro D i.-R. A. Laparoscopic appendectomy: quality et al (2013) [2] did a research on 142 care and cost-effectiveness for today's economy. appendectomy cases (99 LA patients and World J Emerg Surg. 2013, 8 (1), p.45. 43 OA patients) also showed that net costs 3. Dennett K.V, Tracy s, F.S et al. for OA (1.799 euro) was higher than LA Treatment of perforated appendicitis in (1.081 euros). The authors suggest that children: what is the cost?. J. Pediatr Surg. LA technique should be chosen for the 2012, 47 (6), pp.1177-1184. treatment of acute appendicitis due to its 4. r. Dhupar Evankovich, j., O.J.B et al. clinical and economic efficiency. Outcomes of operative management of appendicitis. Surg. Infect (Larchmt). 2012, Hence, LA reduces the rate of 13 (3), pp.141-146. complications, time in hospital and also reduce the costs not directly related to 5. Dubois, l., Vogt K.N., D.W et al. Impact health care and indirect costs. Therefore, of an appendectomy outpatient protocol on the total cost of the LA was lower than clinical outcomes and cost: a case-control study. that of OA, so LA is the best choice for J Am Coll Surg. 2010, 211 (6), pp.731-737. the patients with acute appendicitis. 6. Khan Al-Balushi, Z.N, S.Y, B.K.M et al. Cost comparison between laparoscopic and CONCLUSION open appendectomies are unjustified in children. Sultan Qaboos Univ Med J. 2013, 13 (2), - Time of the LA group (4.2 ± 2.3 days) pp. 275-279. was less than OA (5.2 ± 2.2 days) . - Cost of OA and LA in complicated 7. Lin K.B, Lai Y.N.P, K.R et al. Trends and cases (5,918.7 thousand and 5,247.9 outcomes in the utilization of laparoscopic thousand) was higher than that of the appendectomies are unjustified in a low-income group without complication (5,531.9 thousand population in Taiwan from 2003 to 2011. and 5,126.3 thousand). J Equity Health. 2015, 14, p.100. - The treatment cost of OA was higher 8. j. e. Varela, H.M.W, Nair N.T. Laparoscopy than that of LA, yet the effectiveness of should be the approach of choice for acute LA (96.3%) was higher than OA (93.6%), appendicitis in the morbidly obese. Am Surg (p > 0.05). J. 2008,196 (2), pp.218-222. 171