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Chirurgia 1999 June;12(3):191-8

language: Italian

Cost analysis of surgical resection for rectal carcinoma

Bozzetti F., Majno E., Bozzetti F.


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Background. The purpose of this analysis is to evaluate the costs of two common surgical operations for rectal carcinoma: the anterior resection (RA) and the abdominal-perineal resection (AP).
Methods. The method used to calculate the costs is that of the ''Activity Based costs'' which considers the services patients make use of, namely the routine hospital treatment, the diagnostic, radiology and laboratory activity and the operating theatre activity. For some costs (medical staff, laboratory and radiology tests, operating theatre functioning) the data provided by the Health Department have been used on the basis of the management accounting or of standard reference patterns. Other costs (e.g. drugs) were directly charged to patients on the basis of the actual use. 32 patients were the subject of the study: 16 underwent RA operations and 16 AP‹with an uneventful postoperative course.
Results. The overall costs linked to the two operations were respectively 10,719,195 liras for the RA and 7,858,072 liras for the AP. The DRG refund is of 7,702,000 liras for both operations, therefore the balance is almost even only for the AP ones, provided that no relevant complications arise during the postoperative course.
Conclusions. The DRG refund proves to be insufficient for the surgical treatment of rectal carcinoma. All the more so since RA is the operation preferred by patients (since they want to avoid an artificial anus) and by surgeons. Reducing the hospital stay prior to the operation could save a 5-10% on the overall cost, but the public funding, such as it is now, is not very fit to compensate the scientific activity of research institutions where the study is an integral part of the treatment.

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