Voitk A J, Watts J
Baffin Regional Hospital, Iqaluit, Northwest Territories, Canada.
Int J Circumpolar Health. 1998;57 Suppl 1:702-5.
To review the role of cost analysis in deciding whether to provide laparoscopic cholecystectomy in a remote community, cholecystectomies for Baffin Region residents were reviewed. Actual cost was calculated using known travel costs, per diem costs, and length of stay (LOS) data. Laparoscopic cost was estimated using LOS and conversion data from the literature. Between 1992 and 1995, 72 patients from the Baffin Region had a cholecystectomy, 61 in Iqaluit and 11 in Montreal. Fifty-seven and five, respectively, were suitable candidates for laparoscopic surgery. LOS was 5.6 days in Iqaluit and 3.5 in Montreal. Annual cost was $167,465 (Canadian). Comparable laparoscopic cholecystectomy cost is $45,411, an annual saving of $122,054. Even after equipment depreciation, laparoscopy provides a calculated saving of over $100,000 a year. However, even maximal decrease in bed utilization is less than 0.5 bed per day. Such small decreases do not allow staffing reduction and, thus, most of the projected savings cannot be realized in practice. Therefore, neither costs nor savings can play a supportive role in a decision to provide laparoscopic cholecystectomy in remote communities. This decision would have to be based on other considerations.
为了评估成本分析在决定是否在偏远社区开展腹腔镜胆囊切除术时所起的作用，我们回顾了巴芬地区居民的胆囊切除术情况。实际成本是根据已知的差旅费、每日费用和住院时间（LOS）数据计算得出的。腹腔镜手术成本是利用文献中的住院时间和中转数据估算的。1992年至1995年间，72名来自巴芬地区的患者接受了胆囊切除术，其中61例在伊卡卢伊特，11例在蒙特利尔。分别有57例和5例适合进行腹腔镜手术。在伊卡卢伊特的住院时间为5.6天，在蒙特利尔为3.5天。年度成本为167,465加元。可比的腹腔镜胆囊切除术成本为45,411加元，每年节省122,054加元。即使在设备折旧之后，腹腔镜手术每年仍可节省超过100,000加元。然而，即使病床使用率最大程度下降，每天也不到0.5张床位。如此小的降幅无法减少人员配备，因此，预计的大部分节省在实际中无法实现。所以，成本或节省在决定是否在偏远社区开展腹腔镜胆囊切除术时都无法起到支持作用。这一决定必须基于其他考虑因素。
