Weiland D E, Caruso D M, Wesche D E, Bay R C
Department of Surgery, Maricopa Medical Center, Phoenix, AZ 85010, USA.
JSLS. 1997 Jul-Sep;1(3):285-8.
Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the reasons for the inefficiencies.
In an attempt to determine the reason for inefficiency of charges and length-of-stay for the laparoscopic portion of laparoscopic cholecystectomy, matched pairs of open cholecystectomy and converted laparoscopic cholecystectomy from a data base of 633 patients with cholecystectomies were reviewed. Thirty-five matches for age, sex and similar diagnosis were successful.
Matched pair evaluation disclosed a $6,880 difference in charges, which was attributed solely to the charge for laparoscopy. Subsequent chart analysis showed a high charge for instrumentation, prolonged anesthesia and operative times and longer preoperative delays before surgery. Moreover, no matter what the conversion rate is, open cholecystectomy was more cost effective. However, if there is a conversion rate of 5%, total hospital charges for laparoscopic cholecystectomy would have to be reduced to $12,679 (a reduction of $3,332 from $16,011) to make laparoscopic cholecystectomy cost-effective.
Cost-effective decision tree analysis of matched pair comparisons and sensitivity analysis proves to be an effective technique in evaluating the cost-effectiveness of laparoscopic cholecystectomy in a hospital population.
在一项针对胆囊疾病诊断相关分组（DRG）类别的分析中，发现马里科帕医疗中心（MMC）的收费和住院时间比其他16家地区医院更高。这些对比数据表明MMC效率低下，需要进行审查以确定效率低下的原因。
为了确定腹腔镜胆囊切除术腹腔镜部分收费和住院时间效率低下的原因，我们从633例胆囊切除术患者的数据库中，对开放式胆囊切除术和中转腹腔镜胆囊切除术进行了配对审查。成功匹配了35对年龄、性别和诊断相似的病例。
配对评估显示收费相差6880美元，这完全归因于腹腔镜检查的费用。随后的病历分析显示，器械收费、麻醉时间延长、手术时间延长以及术前延迟时间更长。此外，无论中转率如何，开放式胆囊切除术的成本效益更高。然而，如果中转率为5%，腹腔镜胆囊切除术的总住院费用必须降至12679美元（从16011美元降至3332美元），才能使腹腔镜胆囊切除术具有成本效益。
配对比较的成本效益决策树分析和敏感性分析被证明是评估医院人群中腹腔镜胆囊切除术成本效益的有效技术。
