title: A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.
abstract: OBJECTIVE
  To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme.
  
  
  METHODS
  Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4).
  
  
  RESULTS
  The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) <60% predicted value (P = 0.02, bootstrap 63%) and chronic obstructive pulmonary disease (COPD; P = 0.035, bootstrap 57%). The following model was developed to estimate the total costs: 10 523 + 1894 × COPD + 2376 × DLCO < 60%. The comparison between predicted and observed costs was repeated in 1000 bootstrapped samples to verify the stability of the model. The two values were not different (P > 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523).
  
  
  CONCLUSIONS
  Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements.
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK brunellialex@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Tentzeris
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandri
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: McKenna
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Shan Liung
authors.initials: SL
authors.lastname: Liew
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Milton
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Nilanjan
authors.initials: N
authors.lastname: Chaudhuri
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kefaloyannis
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011013:Pneumonectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data
keywords: Finances; Hospital costs; Practice evaluation; Risk model; VATS lobectomy