Cost analysis of three different surgical procedures for treatment of a pelvic tumour.
BACKGROUND
Malignant pelvic tumours are rare, but adequate treatment is difficult because of anatomical and functional reasons. Different surgical procedures are recommended. Besides aspects influencing the quality of life due to the different surgical techniques, costs of these surgical procedures and the perioperative time interval, depending on the chosen surgical procedure, must also be considered.


METHODS
Costs of three kinds of surgical treatment - internal hemipelvectomy vs external hemipelvectomy and application of an orthotic device vs ilio-femoral pseudoarthrosis - were compared, including costs of the immediate period of rehabilitation. Costs of the preoperative diagnostic procedure were excluded because they were assumed to be equal. For all calculations, treatment of a periacetabular pelvic tumour type II-b was assumed, according to the Enneking classification, with the need for a pelvic resection with wide margins including removal of the hipjoint. This analysis was performed based on the average costs per hour of physicians, nurses and physiotherapists, including a basic daily rate for additional costs, such as housekeeping and administrative costs of the hospital. In all cases, the costs of the operative procedure and the perioperative period up to 3 months were calculated, including the costs for the endoprosthetic device after internal hemipelvectomy and those for the orthotic devices after necessary external hemipelvectomy.


RESULTS
For a postoperative period of 3 months, the cost for treatment with resection of the tumour and performing an ilio-femoral pseudoarthrosis is nearly DM 56,741.54; treatment with an internal hemipelvectomy including the endoprosthetic pelvic replacement costs DM 81,439.34; and treatment with external hemipelvectomy and application of an orthotic device with a pelvic cage costs DM 69,138.46. In this analysis, social costs due to the different rates of disability for years or costs of a new prosthetic device after years and aspects related to resulting quality of life were excluded. In contrast, costs of three different actual cases can differ significantly from the estimated costs. The most important influencing items are surgical implants, blood units and similar products, and surgical treatment of postoperative complications.


CONCLUSIONS
Regarding all these aspects, limb salvage seems to be advantageous over amputation. Whether an ileo-femoral pseudoarthrosis or endoprosthetic pelvic replacement should be performed is a decision that should be made by the physicians. based on the underlying diagnosis and the correlated expected survival. Furthermore, additional factors probably reducing the rate of postoperative complications, such as infections or necrosis following radiotherapy and being summarised under the term "quality of life", should also be regarded.
Bruns
J
J
Department of Orthopaedic Surgery, University of Hamburg, Centre of Biomechanics, Germany.
Luessenhop
S
S
Behrens
P
P
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006428:Hemipelvectomy / Q000191:economics* / Q000379:methods; D018219:Histiocytoma, Benign Fibrous / Q000191:economics / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000191:economics / Q000601:surgery*; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery*; D019919:Prosthesis Implantation / Q000191:economics* / Q000379:methods; D011542:Pseudarthrosis / Q000191:economics*; D016896:Treatment Outcome