Influence of surgeon and hospital volume on radical prostatectomy costs

Stephen Williams, Channa A. Amarasekera, Xiangmei Gu, Stuart R. Lipsitz, Paul L. Nguyen, Nathanael D. Hevelone, Keith J. Kowalczyk, Jim C. Hu

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: While higher radical prostatectomy hospital and surgeon volume are associated with better outcomes, the effect of provider volume on health care costs remains unclear. We performed a population based study to characterize the effect of surgeon and hospital volume on radical prostatectomy costs. Materials and Methods: We used SEER (Surveillance, Epidemiology and End Results)-Medicare linked data to identify 11,048 men who underwent radical prostatectomy from 2003 to 2009. We categorized hospital and surgeon radical prostatectomy volume into tertiles (low, intermediate, high) and assessed costs from radical prostatectomy until 90 days postoperatively using propensity adjusted analyses. Results: Higher surgeon volume at intermediate volume hospitals (surgeon volume low $9,915; intermediate $10,068; high $9,451; p = 0.021) and high volume hospitals (surgeon volume low $11,271; intermediate $10,638; high $9,529; p = 0.002) was associated with lower radical prostatectomy costs. Extrapolating nationally, selective referral to high volume radical prostatectomy surgeons at high and intermediate volume hospitals netted more than $28.7 million in cost savings. Conversely, higher hospital volume was associated with greater radical prostatectomy costs for low volume surgeons (hospital volume low $9,685; intermediate $9,915; high $11,271; p = 0.010) and intermediate volume surgeons (hospital volume low $9,605; intermediate $10,068; high $10,638; p = 0.029). High volume radical prostatectomy surgeon costs were not affected by varying hospital volume, and among low volume hospitals radical prostatectomy costs did not differ by surgeon volume. Conclusions: Selective referral to high volume radical prostatectomy surgeons operating at intermediate and high volume hospitals nets significant cost savings. However, higher radical prostatectomy hospital volume was associated with greater costs for low and intermediate volume radical prostatectomy surgeons.

Original languageEnglish (US)
Pages (from-to)2198-2202
Number of pages5
JournalJournal of Urology
Volume188
Issue number6
DOIs
StatePublished - Dec 2012
Externally publishedYes

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Prostatectomy
Costs and Cost Analysis
Low-Volume Hospitals
High-Volume Hospitals
Cost Savings
Surgeons
Referral and Consultation
Medicare
Health Care Costs
Epidemiology

Keywords

  • health expenditures
  • prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Williams, S., Amarasekera, C. A., Gu, X., Lipsitz, S. R., Nguyen, P. L., Hevelone, N. D., ... Hu, J. C. (2012). Influence of surgeon and hospital volume on radical prostatectomy costs. Journal of Urology, 188(6), 2198-2202. https://doi.org/10.1016/j.juro.2012.08.012

Influence of surgeon and hospital volume on radical prostatectomy costs. / Williams, Stephen; Amarasekera, Channa A.; Gu, Xiangmei; Lipsitz, Stuart R.; Nguyen, Paul L.; Hevelone, Nathanael D.; Kowalczyk, Keith J.; Hu, Jim C.

In: Journal of Urology, Vol. 188, No. 6, 12.2012, p. 2198-2202.

Research output: Contribution to journalArticle

Williams, S, Amarasekera, CA, Gu, X, Lipsitz, SR, Nguyen, PL, Hevelone, ND, Kowalczyk, KJ & Hu, JC 2012, 'Influence of surgeon and hospital volume on radical prostatectomy costs', Journal of Urology, vol. 188, no. 6, pp. 2198-2202. https://doi.org/10.1016/j.juro.2012.08.012
Williams S, Amarasekera CA, Gu X, Lipsitz SR, Nguyen PL, Hevelone ND et al. Influence of surgeon and hospital volume on radical prostatectomy costs. Journal of Urology. 2012 Dec;188(6):2198-2202. https://doi.org/10.1016/j.juro.2012.08.012
Williams, Stephen ; Amarasekera, Channa A. ; Gu, Xiangmei ; Lipsitz, Stuart R. ; Nguyen, Paul L. ; Hevelone, Nathanael D. ; Kowalczyk, Keith J. ; Hu, Jim C. / Influence of surgeon and hospital volume on radical prostatectomy costs. In: Journal of Urology. 2012 ; Vol. 188, No. 6. pp. 2198-2202.
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AB - Purpose: While higher radical prostatectomy hospital and surgeon volume are associated with better outcomes, the effect of provider volume on health care costs remains unclear. We performed a population based study to characterize the effect of surgeon and hospital volume on radical prostatectomy costs. Materials and Methods: We used SEER (Surveillance, Epidemiology and End Results)-Medicare linked data to identify 11,048 men who underwent radical prostatectomy from 2003 to 2009. We categorized hospital and surgeon radical prostatectomy volume into tertiles (low, intermediate, high) and assessed costs from radical prostatectomy until 90 days postoperatively using propensity adjusted analyses. Results: Higher surgeon volume at intermediate volume hospitals (surgeon volume low $9,915; intermediate $10,068; high $9,451; p = 0.021) and high volume hospitals (surgeon volume low $11,271; intermediate $10,638; high $9,529; p = 0.002) was associated with lower radical prostatectomy costs. Extrapolating nationally, selective referral to high volume radical prostatectomy surgeons at high and intermediate volume hospitals netted more than $28.7 million in cost savings. Conversely, higher hospital volume was associated with greater radical prostatectomy costs for low volume surgeons (hospital volume low $9,685; intermediate $9,915; high $11,271; p = 0.010) and intermediate volume surgeons (hospital volume low $9,605; intermediate $10,068; high $10,638; p = 0.029). High volume radical prostatectomy surgeon costs were not affected by varying hospital volume, and among low volume hospitals radical prostatectomy costs did not differ by surgeon volume. Conclusions: Selective referral to high volume radical prostatectomy surgeons operating at intermediate and high volume hospitals nets significant cost savings. However, higher radical prostatectomy hospital volume was associated with greater costs for low and intermediate volume radical prostatectomy surgeons.

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