title: Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability.
abstract: BACKGROUND
  Malignancies of the peritoneum remain a challenge in any hospital that accepts to manage them, due not only to difficulties associated with the complexity of the procedures involved but also the costs, which - in Italy and other countries that use a diagnosis-related group (DRG) system - are not adequately reimbursed.
  
  
  METHODS
  We analyzed data relative to 24 patients operated on between September 2010 and May 2013 with special regard to operating room expenditure, ICU stay, duration of hospitalization, and DRG reimbursement. The total costs per patient included clinical, operating room, procedure, pathology, imaging, ward care, allied healthcare, pharmaceutical, and ICU costs.
  
  
  RESULTS
  Postoperative hospital stay, drugs and materials, and operating room occupancy were the main factors affecting the expenditure for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We had a median hospitalization of 14 days, median ICU stay of 2.4 days, and median operating room occupancy of 585 min. The median expenditure for each case was € 21,744; the median reimbursement by the national health system € 8,375.
  
  
  CONCLUSIONS
  In a DRG reimbursement system, the economic effort in the management of patients undergoing peritonectomy procedures may not be counterbalanced by adequate reimbursement. Joint efforts between medical and administration parties are mandatory to develop appropriate treatment protocols and keep down the costs.
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy. Electronic address: pietro.bagnoli@cancercenter.humanitas.it.
authors.forename: Pietro F
authors.initials: PF
authors.lastname: Bagnoli
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: F C M
authors.initials: FC
authors.lastname: Cananzi
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Brocchi
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ardito
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Strada
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cozzaglio
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mussi
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Brusa
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Carlino
authors.affiliation: Management Control Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Borrelli
authors.affiliation: Management Control Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Alemanno
authors.affiliation: Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Quagliuolo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002277:Carcinoma / Q000191:economics* / Q000556:secondary / Q000628:therapy; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000191:economics* / Q000473:pathology; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics; D065426:Cytoreduction Surgical Procedures / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics*; D007263:Infusions, Parenteral / Q000191:economics; D007558:Italy; D007902:Length of Stay / Q000191:economics; D008297:Male; D008654:Mesothelioma / Q000191:economics* / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000191:economics* / Q000473:pathology; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000191:economics* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000191:economics* / Q000556:secondary / Q000628:therapy; D010537:Peritoneum / Q000601:surgery; D011553:Pseudomyxoma Peritonei / Q000191:economics* / Q000628:therapy; D013514:Surgical Procedures, Operative / Q000191:economics
keywords: Cost analysis; Diagnosis-related group; Hyperthermic intraperitoneal chemotherapy; Peritonectomy