Link Richard E, Su Li-Ming, Bhayani Sam B, Pavlovich Christian P
James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
J Urol. 2004 Jul;172(1):269-74. doi: 10.1097/01.ju.0000128773.99707.5b.
We compared the perioperative costs of laparoscopic radical prostatectomy (LRP) and open radical retropubic prostatectomy (RRP) at a metropolitan hospital by developing a detailed computer model.
Our predictive model incorporates institutional cost centers for operative time, operating room consumables, professional fees, hospital room and board, oral analgesics, autologous blood banking, blood transfusion and cystography. Versions with and without pelvic lymphadenectomy (PLND) were evaluated using 1 and 2-way sensitivity analyses. Operative times, lengths of stay and transfusion rates were derived from published series. We also reviewed individual hospital charges for 172 consecutive prostatectomy cases for comparison and validation of model predictions.
The model predicted cost premiums for LRP of 14.4% (without PLND) and 17.5% (with PLND). The actual hospital charge premium for LRP and PLND was 18.4%, which differed from the predicted cost premium by less than 1%. The most significant cost centers in order of importance were operative time, length of stay and consumables. To achieve cost equivalence with RRP, operative times would need to average 159 minutes (LRP and PLND) and 174 minutes (LRP alone) holding other factors constant. Cost equivalence could not be achieved by shortening hospital stay alone unless LRP were performed as an outpatient procedure.
Our model predicts the perioperative costs of LRP to be greater than RRP by a factor of less than 1.2x. If disposable instruments and trocars are eliminated, and patients undergoing LRP and PLND are discharged on postoperative day 2, cost equivalence with RRP and PLND can be achieved with operative times of 3.4 hours.
我们通过开发一个详细的计算机模型，比较了一家大都市医院腹腔镜根治性前列腺切除术（LRP）和开放性耻骨后根治性前列腺切除术（RRP）的围手术期成本。
我们的预测模型纳入了机构成本中心，涵盖手术时间、手术室耗材、专业费用、住院食宿、口服镇痛药、自体血库、输血和膀胱造影。使用单向和双向敏感性分析评估了有无盆腔淋巴结清扫术（PLND）的模型版本。手术时间、住院时间和输血率来自已发表的系列研究。我们还审查了172例连续前列腺切除术病例的个人医院收费情况，以比较和验证模型预测。
模型预测LRP的成本溢价分别为14.4%（无PLND）和17.5%（有PLND）。LRP和PLND的实际医院收费溢价为18.4%，与预测成本溢价的差异小于1%。按重要性排序，最重要的成本中心依次为手术时间、住院时间和耗材。在其他因素不变的情况下，为了实现与RRP成本相当，LRP（有PLND）的平均手术时间需为159分钟，LRP（无PLND）需为174分钟。除非将LRP作为门诊手术进行，否则仅通过缩短住院时间无法实现成本相当。
我们的模型预测LRP的围手术期成本比RRP高不到1.2倍。如果消除一次性器械和套管针，并且接受LRP和PLND的患者在术后第2天出院，手术时间为3.4小时时可实现与RRP和PLND成本相当。
