Comparison of costs of hospitalization of patients with primary lung cancer after lobectomy with access through classic thoracotomy and VATS in the conditions of financing based on diagnosis-related groups

摘要

Background: One of serious problems in the management of health care units is rational management of financial resources allocated by the government for health care. This management is significantly influenced by the valuation tariff of health care services, including surgical procedures. The assessment of the cost-effectiveness of a particular service has a key role in the selection of procedures performed in a given health care unit. The aim of the study is to assess the costs of lobectomy via thoracotomy and video-assisted thoracoscopic surgery (VATS) in terms of the impact on the overall hospitalization cost and the answer to the question whether differences in hospitalization costs depending on the access are large enough to justify different valuation tariffs for surgery via traditional and minimally invasive access. Methods: This is a retrospective analysis of data on the costs of treatment of patients who underwent lobectomy via traditional access or VATS due to non-small cell lung cancer. Data concerning valuation of the procedure and hospitalization were compared with general costs of hospital treatment of these patients. Results: The study has proven that duration of the procedure (VATS: 145 min, thoracotomy: 143 min) and total value of hospitalization costs depending on the type of access (VATS: €2,235, thoracotomy: €1,500) were similar—the differences did not show statistical significance (P=0.96 and 0.05118). In contrast, the average time of patient stay in the hospital after surgery and the average cost of surgery were significantly different (3.69 for VATS vs . 5.71 days for thoracotomy with P=0.0000084 and €1,705 for VATS and €682 for thoracotomy with P=0.0114). Conclusions: The total cost of patient hospitalization after lobectomy via VATS is similar to the cost of hospitalization after thoracotomy. Similar costs of both treatments with well-known benefits of VATS including shorter hospitalization and better quality of life of the patient speak in favor of a wider use of minimally invasive access with a good effect in the form of economical use of financial resources.