Value Analysis of the Costliest Elective Lifesaving Procedures at an Academic Medical Center

Introduction: When evaluating the cost of a lifesaving operation, one must consider the economic value, which can be defined as the relative cost per additional year of life lived. This evaluation might provide useful information for the application of costly procedures. The objective of this study was to determine the cost per year of life saved for the costliest operations performed at an urban academic medical center.

Methods: Total hospital expenditures were categorized by diagnosis related group (DRG) between January 1, 2015 and December 31, 2016. Average cost and patient age for each procedure were calculated. Average lifespan following successful outcome was determined based upon published benchmarks. Cost per year of life saved was calculated for each procedure. Only those elective procedures necessary to prolong life and enhance health were analyzed.

Results: 114,448 hospital admissions were reviewed. The 12 costliest procedures were identified and ranked according to cost per year of life saved: Coronary bypass ($1,345.45), portacaval shunt procedure ($2,261.70), cardiac valve/other major cardiothoracic procedure ($2,733.78), major bladder procedure ($2,733.78), cardiac defibrillator implant ($5,047.65), bone marrow transplant ($5,181.80), intracranial vascular procedures ($8,572.05), kidney transplant ($9,024.87), liver transplant ($11,112.73), endovascular cardiac valve replacement ($12,842.25), simultaneous pancreas/kidney transplant ($14,087.50), and heart transplant ($20,472.11).

Conclusion: Among the costliest procedures, coronary bypass was the most economic, having the lowest cost per year of life saved ($1,345.45) and longest post-procedure life expectancy (17.6 years). These findings combined with further analysis of the identified procedures may allow us to better determine their relative value.