Cost-analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancy: An Australian perspective with global application.
BACKGROUND
Cost-effective cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of patients with peritoneal malignancy remains an ongoing financial challenge for healthcare systems, hospitals and patients. This study aims to describe the detailed in-hospital costs of CRS and HIPEC compared with an Australian Activity Based Funding (ABF) system, and to evaluate how the learning curve, disease entities and surgical outcomes influence in-hospital costs.


METHODS
A retrospective descriptive costing review of all CRS and HIPEC cases undertaken at a large public tertiary referral hospital in Sydney, Australia from April 2017 to June 2019. In-hospital cost variables included staff, critical care, diagnosis, operating theatre, and other costs. Univariate and multivariate analyses were conducted to investigate the differences between actual cost and the provision of funding, and potential factors associated with these costs.


RESULTS
Of the 118 CRS and HIPEC procedures included in the analyses, the median total cost was AU$130,804 (IQR: 105,744 to 153,972). Provision of funding via the ABF system was approximately one-third of the total CRS and HIPEC costs (p < 0.001). Surgical staff proficiency seems to reduce the total CRS and HIPEC costs. Surgical time, length of intensive care unit and hospital stay are the main predictors of total CRS and HIPEC costs.


CONCLUSION
Delivery of CRS and HIPEC is expensive with high variability. A standard ABF system grossly underestimates the specific CRS and HIPEC funding required with supplementation essential to sustaining this complex highly specialised service.
['McBride|Kate E|KE|', 'Steffens|Daniel|D|', 'Solomon|Michael J|MJ|', 'Koh|Cherry|C|', 'Ansari|Nabila|N|', 'Young|Christopher J|CJ|', 'Moran|Brendan|B|']
D000368:Aged D001315:Australia D002983:Clinical Competence D003365:Costs and Cost Analysis D003422:Critical Care D065426:Cytoreduction Surgical Procedures D019937:Diagnostic Techniques and Procedures D005260:Female D005380:Financing, Government D006282:Health Personnel D017721:Hospital Costs D006779:Hospitals, Public D006801:Humans D000084262:Hyperthermic Intraperitoneal Chemotherapy D059032:Learning Curve D007902:Length of Stay D008297:Male D008875:Middle Aged D009873:Operating Rooms D061646:Operative Time D010534:Peritoneal Neoplasms D012189:Retrospective Studies
Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Cost Funding