Introduction: Radical prostatectomy (RP), although a common treatment for localized prostate cancer, is a complex operation with a significant learning curve. We investigated whether surgeon and hospital volume were associated with procedure cost and hypothesized that high volume surgeons and hospitals would have lower costs of RP.
Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried by Clinical Classification Software diagnosis and procedure codes for men who underwent RP in 2016. This included both open and minimally invasive surgery. We evaluated the total cost of surgical hospitalization for each patient undergoing RP. A generalized linear mixed model with pseudo R2 statistic was employed to determine whether surgeon and hospital volume were associated with low-cost surgery, using surgeon, patient and hospital characteristics as covariates. Low-cost RP was defined as below the 25th percentile ($10,764.34).
Results: This study included 3,132 men undergoing RP by 77 surgeons at 56 hospitals. The median surgeon volume was 59 (IQR: 33-205) and median hospital volume was 123 (IQR: 62-270). The median cost of RP was $12,718.92 (IQR: $10,764.55-16,899.92). The median cost of the low-cost group was $9,586.71 (IQR: $8,750.13-10,330.77). Each additional RP performed by an individual surgeon was associated with a 3% increase in odds of low-cost surgery (OR 1.03, 95% CI 1.01-1.05). Moreover, increased years of practice experience showed increased odds of low-cost surgery (OR 1.05, 95% CI 1-1.10). Pertaining to hospital-level factors, each additional RP performed by a hospital decreased the odds of low-cost surgery by 3% (OR 0.97, 95% CI 0.95-0.99). Surgeon and hospital volume were the greatest contributors to cost variability for RP.
Conclusions: High-volume surgeons are more likely to have low-cost RP. Surprisingly, high-volume New York hospitals are less likely to have low-cost RP. This study improves our understanding of the volume-cost relationship for RP and sheds light on changes to the relationship in a state that has largely embraced centralization of prostate cancer treatment. Source of
