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Reorganizing the system of care surrounding laparoscopic surgery: a cost-effectiveness analysis using discrete-event
James E Stahl1, David Rattner, Richard Wiklund
1Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA. james@mgh-ita.org
Purpose:
To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety.
Methods:
Discrete-event simulation methods were used to compare current surgical practice with a new modular system in which patient care is handed off between 2 anesthesiologists. A health care system's perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume.
Results:
The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d = 5327 dollars v. 5289 dollars) to the current strategy with an incremental cost-effectiveness of 318 dollars/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15 min before the new strategy is no longer more effective.
Conclusion:
The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.
