Regional Variation in the Costs of Urogynecologic Procedures

Objectives: The objective of this study was to determine whether there are regional differences in costs for surgeries for pelvic organ prolapse in the United States using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS).

Methods: Data from the 2017 HCUP NIS was analyzed using Current Procedural Terminology (CPT) codes for prolapse surgeries, including hysteropexy, vaginal vault suspension, minimally invasive sacrocolpopexy, open sacrocolpopexy, and colpocleisis. Patient and hospital characteristics were extracted from the database, including race, income quartile, insurance payors, mortality risk, disease severity, hospital size, hospital designation (private, government, non-profit), and hospital location (rural vs metropolitan). Surgery costs were calculated by converting hospital charges into costs using cost-to-charge ratios. Geographic regions were designated by U.S. Census divisions. Univariate and multivariate analyses were performed using STATA version 16 to determine regional cost of prolapse repair.

Results: A total of 6,901 prolapse surgeries were identified. Table 1 shows the median costs for each type of prolapse repair based on geographic region in the US. Patient factors that significantly impacted the cost of surgery included geographic region, race, insurance, income, morbidity and mortality risk. Cost was also significantly impacted by hospital type and size. After controlling for patient and hospital specific factors for all prolapse repairs the East South Central district (Kentucky, Tennessee, Mississippi, and Alabama) (p = 0.019) and the Middle Atlantic district (New York, New Jersey, and Pennsylvania) (p = 0.034) had decreased costs of surgery when compared to New England (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island). The Pacific District (Alaska, California, Hawaii, Oregon, Washington) had significantly higher surgery costs (p = 0.001) when compared to the other regions. Analysis of surgery cost by type of procedure showed a statistically significant difference in minimally invasive sacrocolpopexy (MISCP) costs across regions, with the Pacific region having an increased cost of $7,709 (95% CI 4624-10794, p < 0.001) when compared to New England (Figure 1).

Conclusions: After controlling for patient and hospital characteristics, there is a significant difference in the cost of performing minimally invasive sacrocolpopexy (MISCP) across the US, with the highest cost in the Pacific region. Patient specific factors which influenced cost of prolapse repair included race, insurance payor, income, and mortality risk. Future studies should identify factors impacting cost variation across the United States.