前立腺全摘術施行症例における前立腺癌診断後1年間の医療経済分析

Abstract

3施設において局所前立腺癌と診断し恥骨後式前立腺全摘除術が施行され, 医療費の計算できた69例を対象に, 1年間にかかる費用を計算し医療経済的効果を検討した.全体の平均の医療費は1436千円, 入院費用は1228千円で全体の約85%を占めていた.そのうち手術は450千円で, 外来費用は208千円であった.更にadjuvant therapyをしていない63例についてneoadjuvant療法施行群(n=27)と未施行群(n=36)に分けて比較してみると, 外来では主に投薬及び注射料においてneoadjuvant施行群が有意に費用がかかっていた.また, 手術・麻酔料や入院管理料をふくめた入院費合計においてもneoadjuvant施行群が高額になっていた.診断時の前立腺特異抗原(PSA)値と内分泌療法の関係をみると, PSA値が高い程, neoadjuvant療法を施行している傾向がみられた.医療費はPSAが高くなるほど有意に高額であった.クリニカルパス(パス)を使用していないA, B各施設別及びパスを使用しているC施設においてパス使用前後の在院日数を比較した結果, A施設, B施設は各々27.8日, 35.4日であった.C施設ではパス導入前は37.0日であったのに対し, パス導入後は16.6日と56%の短縮を認めた.このC施設での医療費の検討では, パス導入前1897千円, パス導入後は1133千円と40%の削減となった

We assessed the 1-year charges in the group of patients undergoing radical prostatectomy and the changes in hospital costs and resource use following implementation of a clinical care path. A total of 69 consecutive men treated with radical prostatectomy for clinically localized prostate cancer were enrolled in the study. Hospital and outpatient records were analyzed for each patient in regard to preoperative, operative and postoperative charges of a 12-month period. Parameters included number of encounters, diagnostic and therapeutic interventions, hospitalization and operative charges, and follow-up visits, diagnostic tests and interventions for 1 year. The mean first-year cost of treatment with radical prostatectomy for localized prostate cancer was 144 x 10(4) yen. The increases in the first-year cost with higher prostate specific antigen (PSA) level for the diagnosis level appeared to primarily be associated with increased inpatient resource use and greater use of hormonal therapy. Length of the stay in a hospital significantly influenced the first-year cost. After implementation of the radical prostatectomy care path hospital costs decreased by 30% (66 x 10(4) yen vs 46 x 10(4) yen), total costs decreased 40% (190 x 10(4) yen vs 113 x 10(4) yen) and length of hospital stay decreased by 56% (37.0 vs 16.6). The first-year costs with radical prostatectomy are influenced greatly by the hormonal therapy and the number of hospital days. By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved toward shorter hospital stays and lower hospital costs.