Using delta/DRG diagrams and decision tree analysis to select a cost-effective surgery for cholecystitis

Area of Science:

• Health Economics
• Surgical Outcomes
• Medical Decision Making

Background:

• Previous cost analyses of cholecystectomy have inconsistently used terms like costs, charges, and expenses.
• Laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) cost-effectiveness requires clear financial and clinical evaluation.

Purpose of the Study:

• To demonstrate a method for selecting the most cost-efficient surgical approach for cholecystitis.
• To utilize DRG diagrams, conversion rate prediction, and sensitivity analysis for financial optimization.

Main Methods:

• Performed Delta DRG analysis on complicated cholecystectomy (DRG 195), identifying outliers in charges and length of stay.
• Assessed conversion rates from LC to OC based on patient data and literature review.
• Constructed decision-tree and sensitivity analyses to determine cost-effectiveness based on conversion probability.

Main Results:

• A hospital was identified as an outlier for DRG 195, with 55% of cases being converted LC.
• Analysis indicated that for routine LC to be cost-effective, its charges must remain below $5,361-$13,084.
• Preoperative findings were used to predict conversion rates and inform cost-efficiency.

Conclusions:

• The integrated method of Delta/DRG, decision-tree, and sensitivity analysis provides a robust framework for evaluating treatment costs.
• This approach enables physicians and hospitals to optimize management strategies for DRG categories, ensuring cost-effectiveness.
• The study highlights the financial implications of conversion rates in laparoscopic cholecystectomy.