title: Cost disparity between health care systems--it's not the surgeons: A cost analysis of thyroid cancer care between the United States and France.
abstract: BACKGROUND
  The cost disparity between the United States and other advanced health care systems, including France, is expanding. In this report we identified the management of papillary thyroid cancer (PTC) that contribute to reimbursement disparity.
  
  
  METHODS
  A tri-institutional, retrospective review included 200 patients with PTC (100 from the United States, 100 from France) treated by total thyroidectomy with/without central neck dissection. A cost model was generated incorporating perioperative management variables (within 1 year) and their reimbursement rates according to the 2014 US Medicare and French government fee-schedules.
  
  
  RESULTS
  In the United States, total thyroidectomy with central neck dissection was more frequent (92% vs 35%, P < .001), median duration of stay was less (1 vs 3 days, P < .001), and use of radioactive iodine was less (66% vs 93%, P < .001), although Thyrogen stimulation was more prevalent (100% vs 43%, P < .001). Overall, the median cost per patient was greater in the United States ($14,069 vs $4,590, P < .001). Reimbursements to the hospital facility accounted for 70% of the disparity, despite lesser durations of stay. Nuclear medicine accounted for 19%, mostly from Thyrogen reimbursement despite less use of radioactive iodine. Surgeon fees accounted for 6%, followed by office visits, laboratory/imaging, anesthesia/pathology fees, and medications.
  
  
  CONCLUSIONS
  The costs of management of PTC are substantially greater in the US compared with France. Efforts to decrease this disparity should focus on reimbursements for hospital facility and use of nuclear medicine imaging.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY. Electronic address: bmf9002@nyp.org.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Finnerty
authors.affiliation: Department of Digestive, Hepato-Biliary and Endocrine Surgery, Universit de Lorraine, CHU Nancy - Hospital Brabois Adultes, Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.affiliation: Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallie
authors.affiliation: Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY.
authors.forename: Caitlin
authors.initials: C
authors.lastname: McIntyre
authors.affiliation: Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY.
authors.forename: Anna
authors.initials: A
authors.lastname: Aronova
authors.affiliation: Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D005791:Patient Care / Q000191:economics*; D012189:Retrospective Studies; D066231:Surgeons / Q000191:economics*; D013964:Thyroid Neoplasms / Q000191:economics*; D013965:Thyroidectomy / Q000191:economics*; D014481:United States / Q000453:epidemiology