Variation in cost of total thyroidectomy across the United States, 2007 to 2008.
BACKGROUND
Variation in cost of surgical care across state lines is poorly understood. We sought to examine state-level variation in wage-adjusted total cost (WATC) of a common surgical procedure.


METHODS
We performed a retrospective cohort study of patients undergoing total thyroidectomy in the Nationwide Inpatient Sample (2007 to 2008). WATC was calculated from charges and adjusted for the area wage index. Hierarchical linear modeling was used to investigate the variation in WATC explained by variables at the patient, hospital, and state levels.


RESULTS
We identified 11,058 eligible patients from 35 states. The overall mean WATC was $8,132; 37% of the WATC variance was because of differences across hospitals, whereas 28% was explained by patient-level factors and 8% because of differences across states.


CONCLUSIONS
More than a quarter of the variation in cost of total thyroidectomy was not explained by patient-, hospital-, or state-level factors. Further research is needed to understand the unexplained residual variation.
Department of Surgery, 4 Silverstein 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Caroline E
CE
Reinke
Department of Surgery, 4 Silverstein 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Elizabeth M
EM
Sonnenberg
Department of Surgery, 4 Silverstein 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Giorgos C
GC
Karakousis
Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Douglas L
DL
Fraker
Department of Surgery, 4 Silverstein 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Rachel.kelz@uphs.upenn.edu.
Rachel R
RR
Kelz
D015331:Cohort Studies; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000191:economics*; D014481:United States
Quality; Thyroidectomy; Variation in cost