title: Evaluation of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a community setting: A cost-utility analysis of a hospital's initial experience and reflections on the health care system.
abstract: BACKGROUND
  The combination of Cytoreductive Surgery (CRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been gaining a considerable interest by surgeons throughout the United States due to the significant survival improvement it provides for peritoneal surface malignancies and the ability to reproduce comparable clinical results in numerous health care centers. However, CRS plus HIPEC has not been sufficiently investigated from the economic standpoint in the United States where a wide variety of health care insurers exists. This study was conducted to analyze hospital/surgeon cost and reimbursement data at a community hospital offering a new peritoneal surface malignancy program, and expand the discussion to analyze future healthcare implementation on this procedure in the United States.
  
  
  METHODS
  This is a retrospective economic analysis of an initial CRS plus HIPEC experience at a community non-teaching medical center. This study was conducted using hospital/surgeon cost and reimbursement based on the Office of Finance data at Edward Hospital Cancer Center (Naperville, IL). All patients who underwent CRS and HIPEC between June 2013 and August 2014 were included in this analysis. We aimed to assess CRS plus HIPEC purely from the financial perspective on the initial admission regardless of the patients' advancement of the disease or postoperative adverse events.
  
  
  RESULTS
  Twenty-five patients underwent 26 CRS plus HIPEC procedures. Twelve patients had private insurance plans (PRV) whereas 13 were covered by public insurers (PUB). Median overall length of stay (LOS) was 10 days (PRV 10 days vs. PUB 11 days; P = 0.76.) Average hospital cost was $38,369 (PRV $37,093 vs. PUB $39,463; P = 0.67), and average reimbursement for our patient population was $45,243 (PRV $48,954 vs. PUB $42,062; P = 0.53). It was noted that CRS plus HIPEC generated more net profit in patients with private insurance than in those with public plans, however, not statistically significant ($11,861 vs. $2,599 per patient, respectively; P = 0.38). Evaluating surgeon's data, average surgeon's charge was $29,139 (PRV $28,440 vs. PUB $29,737; P = 0.80), and average patients' payment was $8,126 (PRV 9,234 vs. PUB 7,176; P = 0.47).
  
  
  CONCLUSIONS
  CRS plus HIPEC is profitable in the community setting for both the hospital and surgeon. Both private and public insurers reimbursed profitably, though with a greater profit margin from private insurers. As CRS plus HIPEC is becoming more widely recognized as a standard of care for patients with peritoneal surface malignancy, it is increasingly important to understand and report its associated costs and variability in insurance coverage, especially in light of the current healthcare structure changes in the United States. It is strongly encouraged to report and present a wider scope of CRS plus HIPEC economic experiences in a variety of hospital settings to provide further evidence for future healthcare implementations in the United States. J. Surg. Oncol. 2016;113:544-547. © 2016 Wiley Periodicals, Inc.
authors.affiliation: University of Illinois at Chicago Medical Center, Department of General Surgery, Chicago, Illinois.
authors.forename: Samer A
authors.initials: SA
authors.lastname: Naffouje
authors.affiliation: University of Illinois at Chicago Medical Center, Department of General Surgery, Chicago, Illinois.
authors.forename: Cristina
authors.initials: C
authors.lastname: O'Donoghue
authors.affiliation: Division of Surgical Oncology, University of Illinois at Chicago Medical Center, Chicago, Illinois.|Department of Surgical Oncology, Edward Hospital, Naperville, Illinois.
authors.forename: George I
authors.initials: GI
authors.lastname: Salti
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D065426:Cytoreduction Surgical Procedures / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D006979:Hyperthermia, Induced / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000191:economics / Q000628:therapy*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
keywords: CRS plus HIPEC; cost utility; community