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Updated: Jul 3, 2026

Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Regionalization versus competition in complex cancer surgery.

Vivian Ho1, Robert J Town, Martin J Heslin

  • 1Baker Institute, Rice University and Department of Medicine, Baylor College of Medicine, Houston, TX 77005, USA.

Health Economics, Policy, and Law
|July 19, 2008
PubMed
Summary

Regionalizing complex surgeries like the Whipple procedure can improve patient survival rates. However, reduced competition may increase costs, potentially offsetting the benefits of better health outcomes.

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Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Health Economics

Background:

  • High hospital procedure volume correlates with reduced mortality for complex surgeries.
  • Regionalization aims to improve outcomes by concentrating procedures at specialized centers.
  • Reduced market competition from regionalization can impact healthcare prices and quality.

Purpose of the Study:

  • To estimate the net benefits of regionalizing Whipple surgery for pancreatic cancer.
  • To analyze the interplay between procedure volume, patient outcomes, and market competition.
  • To predict the economic consequences (consumer surplus) of surgical regionalization.

Main Methods:

  • Confirmed the association between hospital/surgeon volume and lower inpatient mortality.

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  • Modeled the price and outcome effects of concentrating Whipple surgery at varying minimum annual volumes (2, 4, 6 procedures).
  • Calculated consumer surplus to assess the net economic impact of regionalization.

    • Main Results:

    • Increased hospital and surgeon volume are linked to lower inpatient mortality rates.
    • Regionalization can increase consumer surplus, but price increases diminish the value of improved outcomes.
    • Potential price hikes may negate over half the value gained from reduced deaths.

    Conclusions:

    • Regionalization's consumer surplus benefits may be less than outcome improvements alone suggest.
    • Modest outcome improvements from regionalization could result in decreased consumer surplus.
    • A thorough understanding of volume-outcome and competition-price dynamics is crucial before implementing regionalization policies.