Post on 05-Jul-2015
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Pouria MoradiAlexander Hills
Duncan Atherton Simon Wood
Charing Cross Hospital, London
ASC, Perth 2010
Aims
• Assess the financial implications of breast reconstruction
• Establish whether the current gold standard of DIEP is economically viable
Materials and methods• Retrospective audit of:
– Procedure – Length of stay– Reconstructive amendments/corrections– Cost
• For 1 surgeon, at 1 unit, between 2000-07
• Review of surgical diaries cross referenced against electronic patient records
Results• 274 patients• Average age 48 years
• 278 primary breast reconstructions• 366 secondary procedures• Minimum of 1 year follow up• Mean 3 year follow up
Breast reconstruction type vs Length of stay (days)
Cost per Median LOS £1,183 £2,475 £2,888 £ 2,200
Median
Mean
Total number of secondary procedures conducted
Implant
Symmetrisation
Wound care
Total number of secondary procedures conducted
Implant
Symmetrisation
Wound care
What are the financial implications of the additional procedures?
What is the actual cost? THEATRE TIME
• Half day list £3200 » Anaesthetic consultant» ODP Nurse (Band 6)» Theatre nurses (Band 6)» Theatre nurse HCA (Band 2)» Recovery Nurse (Band 6)» A&C Support» Limited non pay consumables
• So a DIEP/TRAM on a full list - £6400• LD and implant - £3200• Implant reconstruction - £1700
What other costs?
• In patient stay (£275 per night)• DIEP/TRAM - 19 hours of one to one nursing -
£253 (vs £600 for ITU)• OPD attendances (New £152, FU £78)• (Mastectomy)• LD/Implants - Prosthesis – (£250 – £700)
Tariff Disparity
• Paid solely for the principle procedure
• Separately the mastectomy tariff is £2623 and axillary surgery £2549 (Total £5172)– In 2009-10 with HRG4 coding it will vary from £5132-7015– As not coded - no research grant for masectomy (£480)
• Immediate reconstruction financially discouraged
Conclusions
• Our belief that autologous reconstruction offers better symmetry at 4-5 years
• Weight change impact on symmetry greater with implants
• Minimal number of procedures– Autologous less secondary procedures than
Implants– Socio-economic costs related to repeat operations
Conclusions
• Tariff system does not encourage immediate or bilateral reconstruction