Open AccessWhat is the cost of endoscopic submucosal dissection (ESD)? A medico‐economic study
Author(s) -
Dahan Martin,
Pauliat Emmanuelle,
Liva-Yonnet Sandra,
Brischoux Sonia,
Legros Romain,
Tailleur Arnaud,
Carrier Paul,
Charissoux Aurélie,
Valgueblasse Virginie,
Loustaud-Ratti Véronique,
Taibi Abdelkader,
Durand-Fontanier Sylvaine,
Valleix Denis,
Sautereau Denis,
Kerever Sébastien,
Jacques Jérémie
Publication year - 2019
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640618810572
Subject(s) - medicine , endoscopic submucosal dissection , reimbursement , odds ratio , confidence interval , gold standard (test) , revenue , surgery , general surgery , finance , health care , economics , economic growth
Endoscopic submucosal dissection (ESD) is the gold‐standard treatment for superficial lesions of the digestive tract. No medico‐economic study has been conducted in Europe. Material and methods A monocentric study was conducted including all patients undergoing ESD between January 2015 and December 2017. The global cost of hospital stays was measured by microcosting, and revenue was based on the diagnosis‐related group (DRG) system. The primary objective was to assess the cost/revenue balance. A medico‐economic comparison with surgery was performed as a secondary outcome. Results A total of 193 patients were prospectively included. The cost per procedure was €3463.79, subtracted from a €2726.84 revenue, with a deficit of −€736.96 per stay. Presence of comorbidities/complications increasing DRG value was the only predictive factor for a positive budgetary balance in a multivariate analysis (odds ratio 49.21, 95% confidence interval 11.3–214.25, p < 0.0001). In comparison with surgery, ESD was associated with shorter length of stay (11 vs 2 days; p < 0.0001) and lower morbidity (28% vs 14%; p = 0.061), lower cost (€8960 vs €1770; p < 0.0001). Conclusion The ESD cost/revenue balance is negative in 80% of cases. Given the benefits of ESD in terms of patient morbidity and financial savings compared with surgery, the implementation of a specific ESD reimbursement is warranted.