Rechazar la cirugía es algunas veces la opción mas costosa

Rechazar la cirugía es algunas veces la opción mas costosa

Refusing Surgery Can Sometimes Be The More Expensive Option

December 26, 2013

According to researchers at Duke Orthopedic Surgery, the lifetime costs of forgoing a surgical operation to repair a torn rotator cuff may be more expensive than undergoing a procedure to fix the issue.

When all factors were accounted for, researchers noted that among patients between the ages of 30 and 79, the average societal savings associated with surgical repairs was $13,771.

Some non-operatives costs that arose as a result of neglecting to have the injury corrected that factored into the total cost savings were:
Fewer employment options
Lower income
Missed work days
Disability payments

Although the operation was no longer cost saving if the patient was over the age of 61, the operation was still cost effective.

“The findings provide a rationale for payer coverage of rotator cuff repair after an initial trial of non-operative treatment,” the researchers wrote in their findings.

The surgery-related savings were even more pronounced if the patient was young. In patients between the ages of 30 and 39, the lifetime societal cost savings was $77,662. Researchers also noted that patients who elected to have the surgery reported a higher quality of life than those who did not undergo the corrective operation.

Despite the encouraging results, the authors cautioned that each patient should be evaluated on a case-by-case basis.

“The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease,” researchers wrote.
Dr. Silverman comments

As doctors, we assume that our treatments improve the quality of life, decrease pain, and improve function. What we don’t know is the cost effectiveness.

I like when studies show the cost effectiveness of a procedure. I would be truly troubled by a study which found that an operation was pain relieving and improved patient function that was not cost effective. How could I fulfill my obligation to relieve pain and suffering when my hands are tied by cost efficacy?

I provide the same three options to patients.

1. Live with it and do nothing (and I tell them the long-term and natural history of the disorder).

2. Manage the problem non-surgically. Again, I reiterate the natural history and when it can and cannot be altered by nonsurgical choices.

3. Fix the problem surgically. I share with them the likely outcomes of the surgery as well as the risks involved.

How does one move cost efficacy into this discussion? Where are the ethical implications?

Can you imagine a doctor saying, “Well, this would relieve your pain, but since it’s not cost efficacious, your insurance won’t cover it. Here are some pills instead.”


Related source: Medscape