This article is more than 5 years old. Information may no longer be current.
Minimally invasive surgery reduced health spending, missed workdays
Click Here to Manage Email Alerts
Compared with standard surgery, certain minimally invasive procedures significantly lowered health plan spending and were associated with less time off from work, according to data published in JAMA Surgery.
In particular, of the six surgical procedures examined, the use of PCI compared with CABG saved health payers $30,850 per patient and drove the cost-saving observed in the study.
Researchers studied adults aged 18 to 64 years from the 2000 to 2009 Truven MarketScan Research Database enrolled in an employer-sponsored health insurance plan who underwent minimally invasive or standard surgery. The surgical procedures included coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization or aortic aneurysm repair. Patients’ health plan spending and workplace absenteeism were tracked from 14 days before to 352 days after the procedure to provide a comprehensive understanding of the economic impact. Primary outcomes included health plan spending on medical and pharmaceutical expenses and days off from work, including vacation, sick leave and short-term disability.
Of the 321,956 participants, 23,814 were employed and had workplace absenteeism data available; 37.6% received standard surgery and 62.4% received minimally invasive surgery. After multivariable adjustment, researchers found the mean health plan spending was lower for minimally invasive surgery for coronary revascularization (–$30,850; 95% CI, –31,629 to –30,091), uterine fibroid resection (–$1,509; 95% CI, –1, 754 to –1,280) and peripheral revascularization (–$12,031; 95% CI, –1,552 to –8,717), but higher for prostatectomy ($1,350; 95% CI, 611-2,212) and carotid revascularization ($4,900; 95% CI, 1,772-8,370).
Researchers also reported that patients undergoing minimally invasive surgery missed significantly fewer days of work for coronary revascularization (mean difference, –37.7 days; 95% CI, –41.1 to –34.3), uterine fibroid resection (mean difference, –11.7 days; 95% CI, –14 to –9.4), prostatectomy (mean difference, –9 days; 95% CI, –14.2 to –3.7) and peripheral revascularization (mean difference, –16.6 days; 95% CI, –28 to –5.2).
“The principal implication of our results for policy is that a focus on evaluating new medical technologies based on their clinical outcomes alone, or even an evaluation including direct medical costs, may be too narrow,” the researchers wrote. They noted that some outcomes, such as increased post-procedure worker productivity, may be difficult to analyze.
However, the researchers also cautioned against broad interpretation of the study results.
“…[O]ur data conceal potentially important differences among the technologies underlying various minimally invasive approaches; ideally, an individual technology should be evaluated on its own merits,” they wrote.
For more information:
Epstein AJ. JAMA Surg. 2013;doi:10.1001/jamasurg.2013.131.
Disclosure: One researcher reports receiving consulting fees from GlaxoSmithKline.
Perspective
Back to Top
Cindy L. Grines, MD
These study results were positive. We have known for a long time that recovery is faster with angioplasty compared with bypass surgery, but the cost data are interesting. There was a $30,000 difference over the course of a year in cost savings for angioplasty. The other finding was return to work. We really don’t have much data on return to work; these results were phenomenal — 38 days less work missed if a patient undergoes angioplasty compared with bypass surgery.
Another interesting point is that even though we presume there would be some restenosis and some repeat procedures during the first year, the cost savings was still more than $30,000 per patient. Clearly, there is a big economic incentive and the patient returns to work sooner, so there are additional financial savings that are rarely mentioned when we do a cost analysis.
Click Here to Manage Email Alerts