子宫切除术相关费用的地域差异。

Geographic Variance of Cost Associated With Hysterectomy.

作者信息

Sheyn David, Mahajan Sangeeta, Billow Megan, Fleary Alexandra, Hayashi Emi, El-Nashar Sherif A

机构信息

Department of Obstetrics and Gynecology and Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio.

出版信息

Obstet Gynecol. 2017 May;129(5):844-853. doi: 10.1097/AOG.0000000000001966.

DOI:10.1097/AOG.0000000000001966

PMID:28383369

Abstract

OBJECTIVE

To estimate whether the cost of hysterectomy varies by geographic region.

METHODS

This was a cross-sectional, population-based study using the 2013 Healthcare Cost and Utilization Project National Inpatient Sample of women older than 18 years undergoing inpatient hysterectomy for benign conditions. Hospital charges obtained from the National Inpatient Sample database were converted to actual costs using cost-to-charge ratios provided by the Healthcare Cost and Utilization Project. Multivariate regression was used to assess the effects that demographic factors, concomitant procedures, diagnoses, and geographic region have on hysterectomy cost above the median.

RESULTS

Women who underwent hysterectomy for benign conditions were identified (N=38,414). The median cost of hysterectomy was $13,981 (interquartile range $9,075-29,770). The mid-Atlantic region had the lowest median cost of $9,661 (interquartile range $6,243-15,335) and the Pacific region had the highest median cost, $22,534 (interquartile range $15,380-33,797). Compared with the mid-Atlantic region, the Pacific (adjusted odds ratio [OR] 10.43, 95% confidence interval [CI] 9.44-11.45), South Atlantic (adjusted OR 5.39, 95% CI 4.95-5.86), and South Central (adjusted OR 2.40, 95% CI 2.21-2.62) regions were associated with the highest probability of costs above the median. All concomitant procedures were associated with an increased cost with the exception of bilateral salpingectomy (adjusted OR 1.03, 95% CI 0.95-1.12). Compared with vaginal hysterectomy, laparoscopic and robotic modes of hysterectomy were associated with higher probabilities of increased costs (adjusted OR 2.86, 95% CI 2.61-3.15 and adjusted OR 5.66, 95% CI 5.11-6.26, respectively). Abdominal hysterectomy was not associated with a statistically significant increase in cost compared with vaginal hysterectomy (adjusted OR 1.01, 95% CI 0.91-1.09).

CONCLUSION

The cost of hysterectomy varies significantly with geographic region after adjusting for confounders.

摘要

目的

评估子宫切除术的费用是否因地理区域而异。

方法

这是一项基于人群的横断面研究，使用2013年医疗保健成本和利用项目全国住院患者样本中18岁以上因良性疾病接受住院子宫切除术的女性。从全国住院患者样本数据库中获取的医院收费，利用医疗保健成本和利用项目提供的成本收费比转换为实际成本。采用多变量回归分析人口统计学因素、伴随手术、诊断和地理区域对高于中位数的子宫切除术成本的影响。

结果

确定了因良性疾病接受子宫切除术的女性（N = 38414）。子宫切除术的中位数成本为13981美元（四分位间距为9075 - 29770美元）。大西洋中部地区的中位数成本最低，为9661美元（四分位间距为6243 - 15335美元），太平洋地区的中位数成本最高，为22534美元（四分位间距为15380 - 33797美元）。与大西洋中部地区相比，太平洋地区（调整后的优势比[OR]为10.43，95%置信区间[CI]为9.44 - 11.45）、南大西洋地区（调整后的OR为5.39，95% CI为4.95 - 5.86）和中南部地区（调整后的OR为2.40，95% CI为2.21 - 2.62）成本高于中位数的可能性最高。除双侧输卵管切除术外（调整后的OR为1.03，95% CI为0.95 - 1.12），所有伴随手术均与成本增加相关。与经阴道子宫切除术相比，腹腔镜和机器人辅助子宫切除术成本增加的可能性更高（分别为调整后的OR为2.86，95% CI为2.61 - 3.15和调整后的OR为5.66，95% CI为5.11 - 6.26）。与经阴道子宫切除术相比，腹式子宫切除术成本增加在统计学上无显著差异（调整后的OR为1.01，95% CI为0.91 - 1.09）。