Drivers of Inpatient Costs in Oncology Patients Undergoing Major Abdominal Surgery: Evidence from a Middle-Income Country
Author(s)
Jorge Medina, MsC1, Díaz Rojas Jorge A., PhD1, Ricardo Merchan, MsC1, Mauricio Chona, Dr2, Lina Maria Lopez, N2, Marjorie Marín, MsC3, Alvaro Vallejos, MsC3, Julián Cruz, MsC4, Daniel Fernando Castro-Goyes, MD5, Ricardo Ballesteros-Ramírez, MSc, PhD5.
1Universidad Nacional de Colombia, Bogotá, Colombia, 2Nutritional Support, Clínicas Colsanitas, Bogotá, Colombia, 3Megalabs, Miami, FL, USA, 4Universidad del Rosario, Bogotá, Colombia, 5Universidad Javeriana, Bogotá, Colombia.
1Universidad Nacional de Colombia, Bogotá, Colombia, 2Nutritional Support, Clínicas Colsanitas, Bogotá, Colombia, 3Megalabs, Miami, FL, USA, 4Universidad del Rosario, Bogotá, Colombia, 5Universidad Javeriana, Bogotá, Colombia.
OBJECTIVES: To identify clinical and sociodemographic factors associated with total inpatient costs in oncology patients undergoing major abdominal surgery at a referral center in a middle-income country.
METHODS: A retrospective observational study was conducted using the institutional database of oncology patients hospitalized between January 2021 and December 2023 in Bogotá, Colombia. Adults with confirmed oncologic diagnoses who underwent major abdominal surgery were included. Cost data were extracted from official itemized hospital invoices. A three-stage modeling strategy was used. First, a multivariable linear model was fitted to assess assumptions and variable significance. Second, a refined log-normal model addressed non-normality and excluded non-significant predictors. Lastly, a non-parametric bootstrapping technique with 1,000 resamples improved confidence interval estimation. Models were estimated using ordinary least squares regression.
RESULTS: A total of 436 patients were included. Median age was 63 years (IQR 54-71), with 231 males (52.98%). Comorbidities included hypertension (33.26%), chronic respiratory disease (5.28%), diabetes (14.22%), and sarcopenia (31.65%). Lower and upper gastrointestinal tumors accounted for 61.47% and 28.44%, respectively. Most surgeries were laparoscopic (86.24%). Tumor staging was localized (40.28%), locally advanced (43.09%), and advanced (16.63%). Median total hospitalization cost was USD 4,472.48 (IQR USD 3,704.73-6,138.73); surgical procedures represented 80%. In the final statistical model, the variables retained as explanatory for total hospitalization costs included respiratory disease, advanced and locally advanced tumor stage, presence of postoperative fistula, and infection. Surgical procedures involving the stomach, esophagus, and Sugar Baker technique were also significant for the model
CONCLUSIONS: This study identified factors associated with hospitalization costs in oncology patients undergoing major abdominal surgery. The average cost was USD 7,642, with a median of USD 4,472. Surgical procedures accounted for the largest cost share. Respiratory disease, upper gastrointestinal surgeries, HIPEC and advanced tumor stage were significantly associated with increased costs. In-hospital infections and fistulas were also independent cost drivers.
METHODS: A retrospective observational study was conducted using the institutional database of oncology patients hospitalized between January 2021 and December 2023 in Bogotá, Colombia. Adults with confirmed oncologic diagnoses who underwent major abdominal surgery were included. Cost data were extracted from official itemized hospital invoices. A three-stage modeling strategy was used. First, a multivariable linear model was fitted to assess assumptions and variable significance. Second, a refined log-normal model addressed non-normality and excluded non-significant predictors. Lastly, a non-parametric bootstrapping technique with 1,000 resamples improved confidence interval estimation. Models were estimated using ordinary least squares regression.
RESULTS: A total of 436 patients were included. Median age was 63 years (IQR 54-71), with 231 males (52.98%). Comorbidities included hypertension (33.26%), chronic respiratory disease (5.28%), diabetes (14.22%), and sarcopenia (31.65%). Lower and upper gastrointestinal tumors accounted for 61.47% and 28.44%, respectively. Most surgeries were laparoscopic (86.24%). Tumor staging was localized (40.28%), locally advanced (43.09%), and advanced (16.63%). Median total hospitalization cost was USD 4,472.48 (IQR USD 3,704.73-6,138.73); surgical procedures represented 80%. In the final statistical model, the variables retained as explanatory for total hospitalization costs included respiratory disease, advanced and locally advanced tumor stage, presence of postoperative fistula, and infection. Surgical procedures involving the stomach, esophagus, and Sugar Baker technique were also significant for the model
CONCLUSIONS: This study identified factors associated with hospitalization costs in oncology patients undergoing major abdominal surgery. The average cost was USD 7,642, with a median of USD 4,472. Surgical procedures accounted for the largest cost share. Respiratory disease, upper gastrointestinal surgeries, HIPEC and advanced tumor stage were significantly associated with increased costs. In-hospital infections and fistulas were also independent cost drivers.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE344
Topic
Economic Evaluation, Real World Data & Information Systems, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Nutrition, Oncology, Surgery