72: Cost Analysis and Financial Implications of Cytoreductive Surgery and HIPEC: a US Single Center Experience

Saturday, March 25, 2023

8:22 AM – 8:32 AM

Location: Ballroom B

Abstract Presenter(s)

Andres A. Abreu, MD (he/him/his)

Postdoctoral Researcher
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Andres A. Abreu, MD (he/him/his)

Postdoctoral Researcher
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose

Author(s)

Emile Farah, MD

Postdoctoral Research Fellow
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
CC

Collin Coble, n/a

Management Analyst
UTSW, United States

Disclosure information not submitted.
BR

Benjamin Rail, n/a

Medical Student
UT Southwestern Medical Center, United States

Disclosure information not submitted.
RA

Rodrigo E. Alterio, MD

Resident
University of Texas Southwestern Medical Center, United States

Disclosure information not submitted.
SS

Shweta Sridhar, n/a

Medical Student
UTSW, United States

Disclosure information not submitted.
YO

Yoma Ogbevire, n/a

Medical Student
UTSW, United States

Disclosure information not submitted.
RN

Robert Nix, MBA

Surgery Department Administrator
UTSW, United States

Disclosure information not submitted.
FN

Fallon Ngo, D.O.

Assistant Professor
UTSW, United States

Disclosure information not submitted.
AW

Anupama Wadwah, M.D.

Professor of Anesthesiology
UTSW, United States

Disclosure information not submitted.
MA

Mathew M. Augustine, M.D.

Assistant Professor
UTSW, United States

Disclosure information not submitted.
Sam C. Wang, MD

Associate Professor
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
Giorgos Karakousis, MD

Professor of Surgery
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
Adam Yopp, MD

Chief, Division of Surgical Oncology
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
Herbert J. Zeh, III, MD

Chair of Surgery
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure information not submitted.
Patricio M. Polanco, MD

MD
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Andres A. Abreu, MD: No financial relationships to disclose

Patricio M. Polanco, MD: No financial relationships to disclose

Introduction: Cytoreductive surgery and hyperthermic peritoneal chemotherapy (CRS/HIPEC) has been shown to improve survival in a select group of patients. This procedure is considered costly and potentially well-reimbursed. Yet, its financial implications have not been extensively explored in the US. This study aims to describe the financial factors impacting hospital costs/collections of CRS/HIPEC at a single academic institution.

Methods: We performed a retrospective cost analysis of all CRS/HIPEC procedures carried out at our NCI-Designated cancer center from Jan-2014 to Jun-2022. Reports of direct and indirect costs, charges, and collections were obtained from the institutional administrative datasets. Payer mix and reimbursed amounts were assessed. High total cost (HTC) was defined as a total cost above the 75th percentile. Bivariate logistic regression was used to analyze factors associated with HTC.

Results: 90 CRS/HIPEC procedures were performed on 88 patients with a median age of 56.5 years (IQR: 48 – 66). The median operative time (OT) was 505 minutes (IQR: 405 – 615), estimated blood loss (EBL) 450 mL (IQR: 187.5 - 700), peritoneal carcinomatosis index (PCI) 17 (IQR: 12 – 24), and length of stay (LOS) 9 days (IQR: 7 – 14). 54 patients (60%) had postoperative complications and 25 (28%) had severe complications (Clavien-Dindo 3-4). No 30-day mortality occurred, and the 90-day mortality was 2%. The 90-day readmission rate was 23%. The median total cost per procedure was $51,067 (IQR: 41,891 – 69,568), of which $38,431 (IQR: 31,273 – 51,725) was direct cost and $12,636 was indirect cost. Median hospital collections were $38,220 (IQR: 23,097 – 67,480) and professional reimbursement was $7,505 (IQR: 5,189 – 12,831) providing a median total reimbursement of $45,725/procedure (IQR: 30,984 – 77,400) accounting for 90% of cost coverage. Payer mix was 57 private and 33 Medicare/Medicaid. Increased LOS, number of organ resections, PCI > 17, EBL > 450 mL, OT > 505 minutes, and the presence of major complications were independent predictors of higher odds of HTC.

Conclusions: CRS/HIPEC is an expensive operation, and the presence of major postoperative complications has the greatest impact on the total cost of the procedure. These findings reaffirm that high-quality care in CRS/HIPEC is not only crucial to improve patient outcomes, but also to maintain the economic sustainability of the procedure.

Learning Objectives:

Understand the factors associated with elevated costs in CRS/HIPEC procedures
Acknowledge the state of this procedure at our institution
Reaffirm the need to provide high-quality of care in CRS/HIPEC surgery in order to avoid complications and to maintain the procedure economically sustainable