Outpatient vs Operating Room Setting for Fort Myers or Naples Treatment of Skin Cancer
TAKE-HOME MESSAGE
- This retrospective study compared the cost of treating skin cancer in different settings by using billing records for 18 operating room and 18 matched outpatient cases. Of the 18 matched pairs, 17 pairs had sufficient data for American Society of Anesthesiologists (ASA) anesthesia grading scale scores to be determined. The median cost for excision of malignant neoplasms in the outpatient setting was significantly lower ($1745) compared with treatment in the operating room ($11, 323).
- This study confirms that treatment of skin cancer in the outpatient setting is more cost-effective than in the operating room.– InYoung Kim, MD, PhD
BACKGROUND
To date, no study has used authentic billing data in a case-control matched fashion to examine the cost of treating skin cancer in different settings.
OBJECTIVE
To compare the cost of surgical treatment of skin cancer in the outpatient versus operating room setting using matched cases based on patient and skin cancer characteristics.
METHODS
ICD-9 diagnosis codes for skin cancers were used to find patients who had a malignant excision current procedural terminology code in the operating room setting during 2010 to 2014. Patient and skin cancer characteristics were used to match cases to those treated as an outpatient. A total of 36 cases (18 operating room and 18 outpatient) had the required information and characteristics to be matched and analyzed for cost. Health status was determined using the American Society of Anesthesiologists anesthesia grading scale.
RESULTS
No statistically significant differences were found in the age (p > 0.9) or American Society of Anesthesiologists scores (p > 0.6) of the outpatient and operating room cases. The median cost for outpatient cases was $1,745. For operating room cases, the median cost was $11,323. This was a statistically significant difference (p < 0.001).
CONCLUSION
The outpatient setting remains a cost-effective location to treat skin cancer compared with the operating room.
This article assesses the costs associated with surgical excision of various skin cancers in an outpatient dermatologic surgery center vs a hospital operating room. There was a marked difference between the two settings, with a median cost for the outpatient cases of $1745 compared with a median cost for operating room cases of $11,323.
There are some clear limitations to this study. First, there were only 19 matched pairs in this small study. Second, direct information was not available for most of the patients to determine why a particular setting was chosen. The cost of care is only one parameter in this complex equation. For example, one of the operating room patients underwent a wide excision of her melanoma and had a sentinel lymph node biopsy at the same time. This would not have been possible in an outpatient office setting. Similar issues may have played a role in the selection of venues for other patients in the study. Third, it appears that the authors assessed only billed charges. Those charges may not have much relationship to actual reimbursement. Finally, one of the hospital cases had an assigned cost of $330,187. This implies that expenses beyond the cost of the specific procedure were included. Thus, the study may be comparing apples to oranges.
Despite these limitations, this article highlights the importance of considering the cost of therapy when making treatment decisions. In today’s “high deductible/high copay” insurance environment, patients are shouldering a growing financial burden for their healthcare. It is important that dermatologists consider the cost to patients of potential care alternatives.