Reorganizing the System of Care Surrounding Laparoscopic Surgery: A Cost-Effectiveness Analysis Using Discrete-Event Simulation

James E. Stahl, David Rattner, Richard Wiklund, Jessica Lester, Molly Beinfeld and G. Scott Gazelle
Additional contact information
James E. Stahl: Department of Radiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, 101 Merimac St., 10th floor, Boston, MA 02114; phone: 617-724-4447; fax: 617-726-9414james@mgh-ita.org , jstahl@partners.org.
David Rattner: Department of Surgery,Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts.
Richard Wiklund: Operating Room Administration, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts.
Molly Beinfeld: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts.
G. Scott Gazelle: Department of Radiology, Department of Health Policy and Management, Harvard School of Public Health, Cambridge, Massachusetts.

Medical Decision Making, 2004, vol. 24, issue 5, 461-471

Abstract: Purpose. To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety. Methods . Discrete-event simulation methods were used to compare current surgical practice with a newmodular system in which patient care is handed off between 2 anesthesiologists. Ahealth care system’s perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume . Results . The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d = $5327 v. $5289) to the current strategywith an incremental cost-effectiveness of $318/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15min before the new strategy is no longermore effective . Conclusion .The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.

Keywords: computer simulation; discrete event simulation; anesthesia; cost-effectiveness (search for similar items in EconPapers)
Date: 2004
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Citations: View citations in EconPapers (8)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:24:y:2004:i:5:p:461-471

DOI: 10.1177/0272989X04268951

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