title: Do prices reflect the costs of cardiac surgery in the elderly?
abstract: BACKGROUND
  Payment for cardiac surgery in Portugal is based on a contract agreement between hospitals and the health ministry. Our aim was to compare the prices paid according to this contract agreement with calculated costs in a population of patients aged ≥65 years undergoing cardiac surgery in one hospital department.
  
  
  METHODS
  Data on 250 patients operated between September 2011 and September 2012 were prospectively collected. The procedures studied were coronary artery bypass graft surgery (CABG) (n=67), valve surgery (n=156) and combined CABG and valve surgery (n=27). Costs were calculated by two methods: micro-costing when feasible and mean length of stay otherwise. Price information was provided by the hospital administration and calculated using the hospital's mean case-mix.
  
  
  RESULTS
  Thirty-day mortality was 3.2%. Mean EuroSCORE I was 5.97 (standard deviation [SD] 4.5%), significantly lower for CABG (p<0.01). Mean intensive care unit stay was 3.27 days (SD 4.7) and mean hospital stay was 9.92 days (SD 6.30), both significantly shorter for CABG. Calculated costs for CABG were €6539.17 (SD 3990.26), for valve surgery €8289.72 (SD 3319.93) and for combined CABG and valve surgery €11 498.24 (SD 10 470.57). The payment for each patient was €4732.38 in 2011 and €4678.66 in 2012 based on the case-mix index of the hospital group, which was 2.06 in 2011 and 2.21 in 2012; however, the case-mix in our sample was 6.48 in 2011 and 6.26 in 2012.
  
  
  CONCLUSIONS
  The price paid for each patient was lower than the calculated costs. Prices would be higher than costs if the case-mix of the sample had been used. Costs were significantly lower for CABG.
authors.affiliation: Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Lisboa, Portugal; Faculdade de Medicina da Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: pedropirescoelho@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Coelho
authors.affiliation: Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rodrigues
authors.affiliation: Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Miranda
authors.affiliation: Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Lisboa, Portugal; Faculdade de Medicina da Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Fragata
authors.affiliation: Faculdade de Economia da Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pita Barros
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics*; D003132:Commerce; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male
keywords: Cardiac surgery; Case mix; Cirurgia cardíaca; Costs; Custos; Preço; Price