Savio George Barreto
Background With the looming fear of costs for cancer care escalating over the next decade, the general aim of policy makers the world over is directing efforts towards “bending the cost curve”. Pancreatic cancer is on the rise and pancreatoduodenectomy is the only curative option available. The aim of the current report is to analyze the published literature on data addressing the issue of costs in pancreatic cancer surgery (with a focus on pancreatoduodenectomy) in an effort to determine how disparate are the lines of investigation of health economics and quality indicators of surgery. Methods A systematic and comprehensive search of major reference databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) was undertaken using a combination of text words “cost”, “pancreatoduodenectomy”, “pancreaticoduodenectomy”, “health care”, “surgery”. The search was restricted to human studies published in literature but was not language restricted. Results The initial search yielded 116 studies of which 25 manuscripts were retrieved for further evaluation. Of the 25 studies retrieved, 7 manuscripts were excluded from the final analysis as the variables analyzed did not significantly influence the costs of pancreatoduodenectomy. The factors most frequently noted (≥2 studies) to influence costs of pancreatoduodenectomy were hospital and surgeon volume the occurrence of complications and the implementation of clinical pathways. Conclusions Using pancreatoduodenectomy, as an example, it is evident that the key to ‘bending the cancer cost curve’ is designing strategies to improve quality of the not only the procedure, but the process. Costs and quality cannot be separated. Reduction in costs can, and must only, be achieved by targeting excellence.
