Pricing of surgeries for colon cancer: patient severity and market factors.
Pricing of surgeries for colon cancer: patient severity and market factors.
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DOI：
10.1002/cncr.27573
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发表时间：
2012-12-01
期刊：
影响因子：
6.2
通讯作者：
Cooper, Gregory
中科院分区：
文献类型：
--
作者：
Dor, Avi;Koroukian, Siran;Xu, Fang;Stulberg, Jonah;Delaney, Conor;Cooper, Gregory
检查HMO渗透、医院竞争和患者严重程度对腹腔镜结肠切除术的接受及其相对于开放手术的价格的影响。我们使用2002-2007年MarketScan数据库来确定接受腹腔镜或开放式部分结肠切除术的私人保险结直肠癌患者的入院情况（n=1,035和n=6,389）。从这些数据中检索患者和健康计划特征；HMO市场渗透率和医院市场集中度指数，赫芬达尔-赫希曼指数（HHI），来源于国家数据库。采用逻辑回归和对数回归来检验腹腔镜结肠切除术的几率、协变量对结肠切除术价格的影响以及腹腔镜手术的差异价格。腹腔镜的采用对市场力量高度敏感，HMO渗透率增加10%导致接受腹腔镜结肠切除术的可能性增加10.3%（调整优势比（AOR）： 1.109, 95%置信区间：1.062,1.158），HHI增加10%导致可能性降低6.6% （AOR: 0.936(0.880, 0.996)）。价格模型显示，腹腔镜手术价格比开放手术低7.6%（转换系数（Coeff）： 0.927(0.895, 0.960)）。HMO普及率增加10%与价格降低1.6%相关（Coeff: 0.985 (0.977, 0.992)）， HHI普及率增加10%与价格升高1.6%相关（Coeff: 1.016(1.006, 1.027)，所有比较p < 0.001）。腹腔镜检查与较低的医院费用显著相关。此外，腹腔镜手术可能会节省成本，而市场压力有助于其采用。
Examine effects of HMO penetration, hospital competition, and patient severity on the uptake of laparoscopic colectomy and its price relative to open surgery for colon cancer. We used 2002-2007 the MarketScan Database to identify admissions for privately insured colorectal cancer patients undergoing laparoscopic or open partial colectomy (n=1,035 and n=6,389, respectively). Patient and health plan characteristics were retrieved from these data; HMO market penetration rates and an index of hospital market concentration, Herfindahl-Hirschman Index (HHI), were derived from national databases. Logistic and logarithmic regressions were used to examine the odds of having laparoscopic colectomy, effect of covariates on colectomy prices, and the differential price of laparoscopy. Adoption of laparoscopy was highly sensitive to market forces, with a 10% increase in HMO penetration leading to a 10.3% increase in the likelihood of undergoing laparoscopic colectomy (Adjusted Odds Ratio (AOR): 1.109, 95% Confidence Interval: 1.062, 1.158), and a 10% increase in HHI resulting in 6.6% lower likelihood (AOR: 0.936 (0.880, 0.996)). Price models indicated that the price of laparoscopy was 7.6% lower than for open surgery (transformed coefficient (Coeff): 0.927 (0.895, 0.960)). A 10% increase in HMO penetration was associated with 1.6% lower price (Coeff: 0.985 (0.977, 0.992)), while a 10% increase in HHI was associated with 1.6% higher price (Coeff: 1.016 (1.006, 1.027), p < 0.001 for all comparisons). Laparoscopy was significantly associated with lower hospital prices. Moreover, Laparoscopic surgery may result in cost savings, while market pressures contribute to its adoption.
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影响因子：
--
作者：
Kiran, RP;Delaney, CP;Fazio, VW
通讯作者：
Fazio, VW
影响因子：
9.7
作者：
Miller, RH;Luft, HS
通讯作者：
Luft, HS
影响因子：
4.2
作者：
BAZZOLI, GJ;MARX, D;MANHEIM, LM
通讯作者：
MANHEIM, LM
影响因子：
3.5
作者：
Brooks, JM;Dor, A;Wong, HS
通讯作者：
Wong, HS
影响因子：
10.7
作者：
Dor, A;Grossman, M;Koroukian, SM
通讯作者：
Koroukian, SM