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Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model

BACKGROUND: Within the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Indepe...

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Autores principales: Campbell, Julie A., Hensher, Martin, Davies, Daniel, Green, Matthew, Hagan, Barry, Jordan, Ian, Venn, Alison, Kuzminov, Alexandr, Neil, Amanda, Wilkinson, Stephen, Palmer, Andrew J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861543/
https://www.ncbi.nlm.nih.gov/pubmed/31190236
http://dx.doi.org/10.1007/s41669-019-0140-5
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author Campbell, Julie A.
Hensher, Martin
Davies, Daniel
Green, Matthew
Hagan, Barry
Jordan, Ian
Venn, Alison
Kuzminov, Alexandr
Neil, Amanda
Wilkinson, Stephen
Palmer, Andrew J.
author_facet Campbell, Julie A.
Hensher, Martin
Davies, Daniel
Green, Matthew
Hagan, Barry
Jordan, Ian
Venn, Alison
Kuzminov, Alexandr
Neil, Amanda
Wilkinson, Stephen
Palmer, Andrew J.
author_sort Campbell, Julie A.
collection PubMed
description BACKGROUND: Within the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model. OBJECTIVE: We aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system. METHODS: Hospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted. RESULTS: A total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267. CONCLUSIONS: Taking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.
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spelling pubmed-68615432019-12-03 Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model Campbell, Julie A. Hensher, Martin Davies, Daniel Green, Matthew Hagan, Barry Jordan, Ian Venn, Alison Kuzminov, Alexandr Neil, Amanda Wilkinson, Stephen Palmer, Andrew J. Pharmacoecon Open Original Research Article BACKGROUND: Within the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model. OBJECTIVE: We aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system. METHODS: Hospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted. RESULTS: A total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267. CONCLUSIONS: Taking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system. Springer International Publishing 2019-06-12 /pmc/articles/PMC6861543/ /pubmed/31190236 http://dx.doi.org/10.1007/s41669-019-0140-5 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Research Article
Campbell, Julie A.
Hensher, Martin
Davies, Daniel
Green, Matthew
Hagan, Barry
Jordan, Ian
Venn, Alison
Kuzminov, Alexandr
Neil, Amanda
Wilkinson, Stephen
Palmer, Andrew J.
Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title_full Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title_fullStr Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title_full_unstemmed Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title_short Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model
title_sort long-term inpatient hospital utilisation and costs (2007–2008 to 2015–2016) for publicly waitlisted bariatric surgery patients in an australian public hospital system based on australia’s activity-based funding model
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861543/
https://www.ncbi.nlm.nih.gov/pubmed/31190236
http://dx.doi.org/10.1007/s41669-019-0140-5
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