1
|
Specchia ML, Specchia ML, Arcuri G, Di Pilla A, Limongelli P, Salgarello M, Masetti R, Bellantone RDA, Bellantone RDA. Insights on DRGs, guideline compliance and economic sustainability. The case of mastectomy with immediate breast reconstruction. Ann Ig 2023; 35:240-249. [PMID: 35603973 DOI: 10.7416/ai.2022.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Immediate breast reconstruction is recommended for eligible patients undergoing mastectomy, raising the issue of economic sustainability of both mastectomy and breast reconstruction performed within the same hospitalization, as opposed to two surgical procedures in two different hospitalizations. Study design A retrospective analysis was conducted to compare economic sustainability of mastectomies with or without immediate breast reconstruction. Methods Economic data on hospitalizations for mastectomy in a Teaching Hospital between 1 January 2019 and 31 March 2021 were analyzed to assess their sustainability. Results 338 admissions were selected (63.9% with immediate breast reconstruction (CI 99%: 57.2% to 70.6%). Compared to mastectomy alone, mastectomy with immediate breast reconstruction had higher cost of € 2,245 (p < 0.001), with operating rooms and devices as main cost drivers. Current reimbursements rates (which are the same for mastectomy alone and for mastectomy with immediate breast reconstruction) led to an average loss of € 1,719 for each mastectomy with immediate breast reconstruction. Conclusion Current DRGs reimbursement rates for hospital admissions for breast cancer surgery do not guarantee immediate breast reconstruction's economic sustainability. DRGs system should be revised, or other solutions as bundled payment should be implemented in the light of the costs of innovation in healthcare, considering mastectomy and breast reconstruction steps in a path of linked actions aimed at improving patients' health.
Collapse
Affiliation(s)
- M L Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M L Specchia
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Arcuri
- Health Technologies and Innovation Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| | - P Limongelli
- Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Salgarello
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - R Masetti
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - R D A Bellantone
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - R D A Bellantone
- Translational Medicine and Surgery Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
2
|
Specchia ML, Di Pilla A, Gambacorta MA, Filippella A, Beccia F, Farina S, Meldolesi E, Lanza C, Bellantone RDA, Valentini V, Tortora G. An IT Platform Supporting Rectal Cancer Tumor Board Activities: Implementation Process and Impact Analysis. Int J Environ Res Public Health 2022; 19:15808. [PMID: 36497903 PMCID: PMC9736877 DOI: 10.3390/ijerph192315808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Colorectal cancer (RC) is the third most common cancer, with an increasing incidence in recent years. Digital health solutions supporting multidisciplinary tumor boards (MTBs) could improve positive outcomes for RC patients. This paper describes the implementation process of a digital solution within the RC-MTB and its impact analysis in the context of the Fondazione Policlinico 'A. Gemelli' in Italy. Adopting a two-phase methodological approach, the first phase qualitatively describes each phase of the implementation of the IT platform, while the second phase quantitatively describes the analysis of the impact of the IT platform. Descriptive and inferential analyses were performed for all variables, with a p-value < 0.05 being considered statistically significant. The implementation of the platform allowed more healthcare professionals to attend meetings and resulted in a decrease in patients sent to the RC-MTB for re-staging and further diagnostic investigations and an increase in patients sent to the RC-MTB for treatment strategies. The results could be attributed to the facilitated access to the platform remotely for specialists, partly compensating for the restrictions imposed by the COVID-19 pandemic, as well as to the integration of the platform into the hospital's IT system. Furthermore, the early involvement of healthcare professionals in the process of customizing the platform to the specific needs of the RC-MTB may have facilitated its use and contributed to the encouraging quantitative results.
Collapse
Affiliation(s)
- Maria Lucia Specchia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Di Pilla
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Filippella
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Flavia Beccia
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Farina
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco Domenico Alfonso Bellantone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giampaolo Tortora
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
3
|
Specchia ML, Arcuri G, Di Pilla A, La Gatta E, Osti T, Limongelli P, Scambia G, Bellantone RDA. The value of uterine oncological surgery in a University Hospital. Results of a break-even analysis. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital.
Methods
An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated.
Results
1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 € - 1852.66 €) without a significant difference for 30-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06).
Conclusions
The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital.
Key messages
• The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery.
• The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.
Collapse
Affiliation(s)
- ML Specchia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - G Arcuri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - A Di Pilla
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - E La Gatta
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - T Osti
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - P Limongelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| | - RDA Bellantone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
- Università Cattolica del Sacro Cuore , Rome, Italy
| |
Collapse
|
4
|
Specchia ML, Arcuri G, Di Pilla A, La Gatta E, Osti T, Limongelli P, Scambia G, Bellantone RDA. The value of surgical admissions for malignant uterine cancer. A comparative analysis of robotic, laparoscopic, and laparotomy surgery in a university hospital. Front Public Health 2022; 10:920578. [PMID: 36276379 PMCID: PMC9582355 DOI: 10.3389/fpubh.2022.920578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Background Robotic surgery for malignant uterine cancer raises issue of economic sustainability for providers. The objective of this study was to assess the value of surgical admissions for malignant uterine cancer in a University Hospital through an analysis of their costs and outcomes by comparing three different surgical approaches (laparotomy, laparoscopic, and robotic surgery). Methods Hospitalizations between 1 January 2019 and 31 October 2021 for malignant uterine cancer surgery were selected and stratified. For each surgical approach, mean values (with 95% confidence intervals, CI) were calculated for cost items. Moreover, 30-day readmission frequency was calculated for the three approaches compared to each other. ANOVA and Student's t-test and relative risk (RR) were used for statistical analysis. A break-even analysis was carried out by evaluating the volume of robotic and non-robotic surgical admissions. Results A total of 1,336 hospitalizations were included in the study, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery, compared to laparoscopic and laparotomy ones, showed a statistically significant difference (p < 0.001) in the economic margin, which was largely negative (-1069.18 €; 95%CI:-1240.44--897.92 €) mainly due to devices cost, and a lower percentage of 30-day readmissions (1.4%; 95%CI: 0.2-2.6%), with a statistically significant difference only vs. laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 €-1852.66 €) without a significant difference for 30-day readmissions. Break-even analysis showed that, on average, for each malignant uterine cancer elective surgery performed laparoscopically, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23-2.06). Conclusion Break-even analysis could be a useful tool to support hospital management in planning and governance of malignant uterine cancer surgery. Systematic application of this tool will allow defining over time right distribution of robotic, laparoscopic, and laparotomy surgeries' volumes to perform to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery. Concerning research, this study paves the way for a multicentric study, the extension of outcomes of malignant uterine surgery to be considered and assessed, and the future inclusion of other therapeutic interventions in the analysis.
Collapse
Affiliation(s)
- Maria Lucia Specchia
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Arcuri
- Health Technologies and Innovation Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Di Pilla
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Andrea Di Pilla
| | - Emanuele La Gatta
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Osti
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Prospero Limongelli
- Health Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Life Sciences and Public Health Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy,Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Rocco Domenico Alfonso Bellantone
- Clinical Governance Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Translational Medicine and Surgery Department, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|