WHAT IS THE COST OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN FRANCE? A PROSPECTIVE MEDICO-ECONOMIC STUDY

Aims:

The Health Insurance System has not delivered a listing of price quotation concerning Endoscopic submucosal dissection (ESD). The primary aim is to assess the costs and benefits of ESD. The secondary aim is to determine predictive factors for a benefit.

Methods:

A monocentric prospective study including all hospitalized ESD patients was conducted from 01/2015 to 05/2017. The total cost of hospital stays was calculated by summing up the SMD (sterile medical devices) used for ESD using a micro-costing approach and the average cost of one day ESD hospitalization extrapolated from the results of ENC (National Cost Study). The hospital's share in the earnings is based on DRG (Diagnosis Related Groups). The difference between the overall cost and the revenue provide the medico-economic study. Univariate comparisons employ the Fisher exact test for qualitative variables and the Wilcoxon rank test for quantitative variables.

Results:

129 patients were included. The location was 59 rectum (47%), 18 oesophagus (14%), 13 stomach (10%) and 37 colon (29%). 64 (49.6%) patients had a positive budgetary balance while 65 (50.4%) had a negative one. The daily cost of hospitalization for ESD was evaluated at € 415. Average SMD spendings was € 1,002.48. The average cost of hospital stays was € 2,415 and revenue per stay was € 2,876.12. The hospital generated a profit of € 61,119.59. SMD correspond to 41.5% of the total expenditure. The multivariate analysis reveal 5 predicting benefit factors: procedure time under 130 min (OR 5.92), diameter over 40 mm (OR 5.92), presence of cancer (OR 2.61), using less than 2 knives (OR 2.73) and a DRG severity level > 1 (OR 38.58) with IC95% and p < 0,05

Conclusions:

The ESD costbenefit balance is slightly positive. SMD accounts for the largest share of expenditures. Given the benefits in terms of patients morbidity and mortality, implementing a specific ESD act or a flat-rate reimbursement turns out to be quite necessary.