Economic impact of tension-free vaginal tape surgery for urinary incontinence in an ambulatory regimen compared with hospital admission: a study of the minimization of costs of a public hospital in Spain.
OBJECTIVE
To determine the cost per patient of a tension-free vaginal tape procedure involving major ambulatory surgery (MAS) compared with inpatient surgery in 2002 and 2003, and to analyse the medical care given following each procedure in a public hospital in Spain.


METHODS
The method used was activity-based costing, which involves designing a protocol of processes of caring for the patient with the help of professionals and subsequently calculating the cost of each process; this system was applied retrospectively to patients cared for in 2002 and 2003. In addition, the clinical histories of these patients were reviewed in order to evaluate complementary care given by the emergency service and admissions to hospital immediately following surgery. The relation between these events and each sample group was analysed by means of a non-parametric test and CIs for a 95% level of significance were obtained in order to make the calculations more robust.


RESULTS
The mean cost for the patients in the ambulatory group was 42.43% lower than that for the hospitalized patients. Whereas 5.5% of the ambulatory patients subsequently required admission and a further 7.3% required complementary medical care, 19.2% of the patients who had been hospitalized for the surgery required complementary medical care and 1.4% were readmitted after intervention. In spite of these results, there was no dependence between these variables according to the chi(2) test.


CONCLUSIONS
MAS produced better results in terms of minimizing costs; under our conditions it was less costly but was of equal efficacy to the surgical intervention.
Moreno
Karen
K
Department of Business Administration, Public University of Navarra, Pamplona, Navarra, Spain. karen.moreno@unavarra.es
Montesino
Manuel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008875:Middle Aged; D005791:Patient Care / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D011182:Postoperative Care; D013030:Spain; D053825:Suburethral Slings / Q000191:economics*; D014549:Urinary Incontinence / Q000191:economics* / Q000601:surgery*