Abstract
Purpose:
While higher radical prostatectomy hospital and surgeon volume are associated with better outcomes, the effect of provider volume on health care costs remains unclear. We performed a population based study to characterize the effect of surgeon and hospital volume on radical prostatectomy costs.
Materials and Methods:
We used SEER (Surveillance, Epidemiology and End Results)-Medicare linked data to identify 11,048 men who underwent radical prostatectomy from 2003 to 2009. We categorized hospital and surgeon radical prostatectomy volume into tertiles (low, intermediate, high) and assessed costs from radical prostatectomy until 90 days postoperatively using propensity adjusted analyses.
Results:
Higher surgeon volume at intermediate volume hospitals (surgeon volume low $9,915; intermediate $10,068; high $9,451; p = 0.021) and high volume hospitals (surgeon volume low $11,271; intermediate $10,638; high $9,529; p = 0.002) was associated with lower radical prostatectomy costs. Extrapolating nationally, selective referral to high volume radical prostatectomy surgeons at high and intermediate volume hospitals netted more than $28.7 million in cost savings. Conversely, higher hospital volume was associated with greater radical prostatectomy costs for low volume surgeons (hospital volume low $9,685; intermediate $9,915; high $11,271; p = 0.010) and intermediate volume surgeons (hospital volume low $9,605; intermediate $10,068; high $10,638; p = 0.029). High volume radical prostatectomy surgeon costs were not affected by varying hospital volume, and among low volume hospitals radical prostatectomy costs did not differ by surgeon volume.
Conclusions:
Selective referral to high volume radical prostatectomy surgeons operating at intermediate and high volume hospitals nets significant cost savings. However, higher radical prostatectomy hospital volume was associated with greater costs for low and intermediate volume radical prostatectomy surgeons.
References
- 1 : Cancer statistics, 2010. CA Cancer J Clin2011; 60: 277. Google Scholar
- 2 : Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst2011; 103: 117. Google Scholar
- 3 : In Health Reform, a Cancer Offers an Acid Test. : The New York TimesJuly 8, 2009. Google Scholar
- 4 : Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery1999; 125: 250. Google Scholar
- 5 : A hospital's annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg1998; 2: 186. Google Scholar
- 6 : Variations in morbidity after radical prostatectomy. N Engl J Med2002; 346: 1138. Crossref, Medline, Google Scholar
- 7 : Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst1999; 91: 1950. Google Scholar
- 8 : The effect of hospital volume on mortality and resource use after radical prostatectomy. J Urol2000; 163: 867. Link, Google Scholar
- 9 : High radical prostatectomy surgical volume is related to lower radical prostatectomy total hospital charges. Eur Urol2006; 50: 58. Google Scholar
- 10 : Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care2002; 40: IV. Google Scholar
- 11 : Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA2009; 302: 1557. Google Scholar
- 12 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Washington, D.C. 2008. Google Scholar
- 13 : Discretionary decision making by primary care physicians and the cost of U.S. health care. Health Aff (Millwood)2008; 27: 813. Google Scholar
- 14 : Variations in surgeon volume and use of pelvic lymph node dissection with open and minimally invasive radical prostatectomy. Urology2008; 72: 647. Google Scholar
- 15 : Surveillance, Epidemiology, and End Results (SEER) limited-use data set. http://seer.cancer.gov. Accessed January 2012. Google Scholar
- 16 : Cost implications of the rapid adoption of newer technologies for treating prostate cancer. J Clin Oncol2011; 29: 1517. Google Scholar
- 17 : Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA2000; 284: 3028. Google Scholar
- 18 : Hospital volume differences and five-year survival from breast cancer. Am J Public Health1998; 88: 454. Google Scholar
- 19 : Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol2003; 21: 401. Google Scholar
- 20 : Temporal trends in radical prostatectomy complications from 1991 to 1998. J Urol2003; 169: 1443. Link, Google Scholar
- 21 : Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol2008; 180: 820. Link, Google Scholar
- 22 : Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol2011; 28: 243. Google Scholar
- 23 : Low annual caseloads of United States surgeons conducting radical prostatectomy. J Urol2009; 182: 2677. Link, Google Scholar
- 24 National Cancer Institute Funded Research Portfolio. http://www.cancer.gov/researchandfunding. Accessed January 2012. Google Scholar
- 25 : How DRGs hurt academic health systems. J Am Coll Surg2001; 193: 1. Google Scholar
- 26 : Wide variation in hospital and physician payment rates evidence of provider market power. Res Brief2010; 16: 1. Google Scholar
- 27 Medicare Payment Advisory Commission: Report to the Congress: Medicare Payment Policy. Washington, D.C. 1998; p v. Google Scholar
- 28 : Slowing the growth of health care costs–lessons from regional variation. N Engl J Med2009; 360: 849. Google Scholar
- 29 : Relationship between regional per capita Medicare expenditures and patient perceptions of quality of care. JAMA2008; 299: 2406. Google Scholar
- 30 : Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol2011; 29: 235. Google Scholar
