Cost and quality of life in thoracic surgery--a health economic analysis in a German center

BACKGROUND: A critical look at the effectiveness of medical procedures and therapies is important with the increasing limitations on resources in health care. METHOD: The costs for treatment and the quality of life according to the SF-36 were analyzed in a retrospective health economic study on 65 patients who had undergone surgery for primary non-small-cell lung cancer. RESULTS: The mean cost for all patients was 7,169 euro per patient. 38.8 % resulted from surgery, 31.6 % were attached to the preoperative phase on the general ward, 11 % postoperatively to the general ward. Intensive care costs accounted for 18.7 %. The cost of each surgical procedure ranged from 4,634 euro for a pneumonectomy to 8,366 euro for a lobectomy with sleeve resection of the bronchus. The most expensive factors were staff, disposable materials, pathological investigations, and radiology services. There was no difference in these proportions with stage of tumor or the surgical procedures undertaken. Quality of life as assessed by the SF-36 questionnaire ranged from 31.82 (physical functioning) to 75.0 (social functioning) one year after the operation. These scores were lower than for those with other chronic diseases. On average, 4.62 quality-adjusted life years were achieved. The cost per QALY was 1,970 euro. The extent of resection and the tumor staging correlates significantly with the mean cost per QALY. CONCLUSION: Thoracic surgery is cost intensive. With increasing staging of the tumor, the cost for treatment increased as with increased operation complexity.