Costs and Clinical Outcomes of Colorectal Cancer Surgeries: Results From the Emilia-Romagna Surgical Colorectal Audit (ESCA)

OBJECTIVES: The primary objective of this analysis was to assess the financial burden of surgical and post-operative activities for the management of colorectal cancer patients during a systematic auditing activity in 7 Surgical Units of Emilia-Romagna.

METHODS: The economic analysis was conducted acquiring information from multiple administrative databases. The study evaluated the cost of the hospitalization for the colorectal surgery (index hospitalization), inpatient, outpatient and drugs costs after 90 days from the hospitalization discharge. This economic analysis adopted the perspective of the Regional Healthcare Service. Direct costs were measured using the current Regional tariffs. Due to the non-randomized nature of the study, propensity score full matching was used for assessing the differences between the open and minimally-invasive (MI) approaches. A Gamma model and a Zero-inflated Gamma model were used to model the index hospitalization costs and the cost-drivers associated with post-operative 90-day costs, respectively. The whole Italian territory’s scenario was also studied. Both DSA and PSA were performed.

RESULTS: The median expenditure during the index hospitalization was 10,752€ (IQR: 7,113.40€-11,317.80€). The occurrence of complications (+28%), high ECOG (+4%), multi-comorbidity (+7%) and a high anesthesiological risk (+5%) increase the index hospitalization cost. Conversely, MI surgery decreases the cost by 14%. Among patients who received at least one clinical service after the index hospitalization discharge, aged<71, with low comorbidity index, who underwent open surgery without complications, the average cost per-patient per-month (PPPM) in the 90-days follow-up was 1662.01€/PPPM. MI approach, ceteris paribus, decreased costs by 28%. Sensitivity analysis also confirmed the dominance of the MI approach.

CONCLUSIONS: The results show that significant cost savings can be achieved for the entire healthcare system by adopting a minimally invasive approach and by reducing the occurrence of postoperative complications, while ensuring better surgical outcomes for patients.