Elsevier

European Journal of Cancer

Volume 34, Issue 13, December 1998, Pages 2015-2020
European Journal of Cancer

Original Paper
Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer

https://doi.org/10.1016/S0959-8049(98)00258-5Get rights and content

Abstract

The aim of this study was to determine the effect of the reduction of the length of hospital stay after surgery for breast cancer on the rate of care consumption and the cost of care. Patients with operable breast cancer were randomised to a short or long postoperative hospital stay. Data on care consumption were collected for a period of 4 months in diaries administered by patients, and socioeconomic status was evaluated by questionnaires. A cost minimisation analysis using the ‘societal’ perspective was performed and savings were compared with the savings of hospital charges. The use of professional home care was higher for the short stay group during the first month (7.2 versus 1.3 h, P<0.0001). The number of out-patient consultations, the intensity of informal home care and patient’s expenses did not increase after early discharge. The total cost of care was reduced by US$1320 by introducing the short stay programme (P=0.0007), but the savings were substantially lower than the savings in hospital charges (US$2680).

Introduction

In-patient hospital care constitutes the major expense in the initial treatment of cancer[1]. Shifting treatment to a short stay in hospital or out-patient procedures is one of the measures expected to reduce the expenses of cancer care. Breast cancer is the most frequent newly diagnosed cancer in women. The savings realised by shortening hospitalisation after initial surgical treatment may be substantial[2].

Most breast cancer patients require surgery for treatment of the primary tumour and for staging of the disease by axillary dissection. Postoperatively, some form of care is necessary for wound and drain management and psychosocial support. Early discharge from hospital is realised by shifting hospital care to out-patient care and to professional and informal home care. In The Netherlands, professional home care is delivered by general practitioners, physiotherapists, district nurses and home helps. Informal care is defined as care provided by relatives, neighbours, friends and volunteers[3]. The extent of substitution between intramural care and home care, and the care intensity used by this category of patients in the different settings, are unknown. Studies of the economic effects of early discharge after breast cancer surgery have mainly focused on savings of hospital charges without taking into account additional costs of out-patient care and home care4, 5, 6, 7, 8. A shift in costs may counteract the savings achieved by shortening hospitalisation.

We conducted a randomised trial to assess the medical, psychosocial and economic effects of early hospital discharge after surgery for breast cancer. The results of the medical and psychosocial evaluation have been described previously[9]. There were no statistically significant differences between the two groups in the incidence of wound complications, seroma formation, or physical or psychological complaints, in the experience of psychosocial problems, or in coping strategies used.

In this paper we present the results of the economic evaluation. The aim of the economic evaluation was to determine the effect of the reduction of the length of hospital stay after breast cancer surgery on the rate of care consumption and the costs of professional and informal care, both within and outside the hospital.

Section snippets

Patients

The sample comprised a consecutive series of patients with stage I or II breast cancer who had surgery for a primary tumour in the breast and axillary dissection between October 1993 and April 1995. Patients were excluded if they had received pre-operative radiotherapy or chemotherapy, were at high risk of complications (ASA classification 3 and higher), or were mentally incompetent; patients who had difficulty with the Dutch language or an inappropriate home situation were also excluded. The

Patient groups

During the study period, 173 women were operated on for breast cancer, of whom 139 were randomised. Reasons for non-randomisation were: refusal to participate (n=22), an unsatisfactory home situation (n=10) and not having been asked to participate (n=2). A further 14 women were excluded after randomisation because they were allocated to another form of treatment (n=4), or withdrew from participation (n=10) for several reasons. Data from the daily diary (first month) were available for 120 (61

Discussion

In this study, the effect of shortening the stay in hospital after surgery for breast cancer on the consumption and the cost of care was studied by means of a prospective randomised trial. The shortening of hospitalisation resulted in a potential cost reduction of 30% of the total cost of postoperative care. We analysed costs from the ‘societal’ perspective. This implies that not only costs made within the health care system are taken into account, but also the costs of informal care and costs

Acknowledgements

We thank Mr J. Collaris for valuable advice. We are grateful to all the participants who enrolled in the trial and to those who contributed and are not mentioned here. The study was funded by the Ministry of Welfare, Health, and Sport, The Netherlands.

References (19)

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