Cost-minimisation analysis of vaginal wall repair in an inpatient or outpatient regimen.
BACKGROUND
The study's objective was to compare the cost of vaginal wall repair under local anesthesia, undertaken in either an inpatient or an outpatient regimen. The perspective used was that of a department of gynecology over the short and medium term.


METHODS
The analysis was based on 2 consecutive cohorts of inpatients and outpatients treated in a Danish university hospital. Data on resource use were collected from clinical records and via a patient telephone survey. Salary and drug costs were estimated from national sources. Costs for consumables, complications and overnight stays were estimated from local data. The analysis compared the costs of inpatient and outpatient surgery relating to staff time, anesthesia, operation, recovery, overnight stays and complications. Multiple regression was employed to adjust for confounding variables.


RESULTS
The average cost was estimated to be 10,400 DKK per inpatient and 6,100 DKK per outpatient (2004 price level: 1 euro = 7.50 DKK). Costs relating to overnight stays and staff costs during operation were the largest contributors to the cost difference. Total cost was significantly associated with type of regimen (in- or outpatient), type of operation and complications. After adjustment for confounding variables, the cost difference was estimated at 3,700 DKK (95% bootstrap confidence interval: 2,500-5,000 DKK). The risk of complication was similar for the 2 regimens.


CONCLUSIONS
Vaginal wall repair under local anesthesia, undertaken in an outpatient regimen, appears to be less costly than in an inpatient regimen.
Sørensen
Jan
J
Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Denmark. jas@cast.sdu.dk
Axelsen
Susanne Maigaard
SM
D000556:Ambulatory Surgical Procedures / Q000191:economics*; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003718:Denmark; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*