Minimally invasive RP cuts absenteeism, raises costs

Minimally invasive prostatectomy leads to a significant decrease in workplace absenteeism but is also associated with an increase in mean health plan spending, according to a recent study.

Led by Andrew J. Epstein, PhD, of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, the study examined six types of surgery: prostatectomy, coronary revascularization, uterine fibroid resection, peripheral revascularization, carotid revascularization, and aortic aneurysm repair. The authors compared health plan costs and workplace absence results for minimally invasive surgical procedures against similar findings for standard, open surgical approaches.

The study, which was published online in JAMA Surgery (March 20, 2013), focused on adults aged 18 to 64 years enrolled in employer-sponsored health insurance plans, and assessed health plan expenditures for medical and pharmacy costs, as well as days absent from work, including vacation, sick leave, and short-term disability. The authors examined trends from a sample of 321,956 patients, of whom 23,814 were employees with available workplace absenteeism data.

"We wanted to look at this issue because we saw a gap in discussions of what value really means in medical care," Dr. Epstein said. "Clinical outcomes are obviously important, but they shouldn’t be the sole measure of potential benefit. Recovery times also matter. How quickly people can get back to work, and the effects on their employers’ bottom lines, are both real and important factors for assessing value."

The authors concluded that minimally invasive procedures for three of the six surgeries resulted in significantly lower health plan spending, and four resulted in significantly fewer days of work absence. After accounting for patients’ health care spending and absenteeism in the year prior to surgery, the most dramatic health plan spending differences and days absent were for minimally invasive coronary revascularization (–$30,850 and 37.7 fewer days per procedure).

For minimally invasive prostatectomy, however, adjusted mean health plan spending over the perioperative and postoperative time frame was significantly higher ($1,350). Mean health spending was also higher for carotid revascularization ($4,900). Spending was lower for minimally invasive coronary revascularization (–$30,850), uterine fibroid resection (–$1,509), and peripheral arterial revascularization (–$12,031), while spending reductions for aortic aneurysm repair were not statistically significant. Adjusted mean days absent were nominally lower for all procedures, and statistically significantly lower for minimally invasive prostatectomy, coronary revascularization, uterine fibroid resection, and peripheral revascularization.

Based on findings for the procedures in the study and using 2009 population and cost figures, the authors calculated a national reduction of $8.9 billion in health plan spending and 53,134 person-years in worker absenteeism, worth an estimated additional $2.2 billion. If minimally invasive surgery had been used for all patients undergoing the six procedures in 2009, the sum of the effects would exceed $14 billion, 22% of which would have come from reductions in worker absenteeism.

"This study is a useful window into the effects of certain technologically advanced surgical procedures for patients and their employers, and it should also help to inform the national debate about how to define better care at lower costs," said Robert J. Rubin, MD, of Georgetown University, Washington, who was not involved in the study but is an employee of the Institute for Health Technology Studies (InHealth), an independent, nonprofit organization that funds research and analysis on the impact and value of medical devices and diagnostics. InHealth provided funding for the study, and one of Dr. Epstein's co-authors has received consulting fees from GlaxoSmithKline.