Hospital costs associated with adverse events in gynaecological oncology

44 45 Background and objective: Treatment for gynaecological malignancies is complex and may 46 cause unintended or accidental adverse events (AE). We evaluated the costs of hospitalization 47 associated with those AEs among patients who had an abdominal or laparoscopic procedure 48 for proven or suspected gynaecological cancer at a tertiary gynaecological cancer center in 49 Australia. 50 51 Methods: Data on AEs were prospectively collected and matched with cost data (AU$ 2008) 52 from the hospital’s clinical costing unit and linked to demographical, clinical and 53 histopathological data. Total costs were adjusted for various clinical factors and estimated 54 using log-transformed ordinary least squared regression. Back-transformation was achieved 55 using smearing factors. From epidemiological data, we also estimated the costs of AEs 56 Australia-wide and undertook scenario and probabilistic sensitivity analyses to investigate the 57 potential cost impact of reducing AEs. 58 59 Results: A total of 369 patients had surgical procedures of which 95 patients (26%) had at 60 least one AE. Patients with AEs incurred an extra AU$ 12,780 on average, adjusted for age, 61 co-morbidities, ovarian cancer, major or minor complications, surgical complexity, presence 62 of malignancy and abdominal surgery. Mean adjusted costs (95% CI) for patients with intra63 operative, minor post-operative and major post-operative AEs were AU$ 40,746 (11,58264 71,859) AU$ 18,459 (17,270-19,713) and AU$ 67,656 (5,324-131,761), respectively. Up to 65 an estimated AU$ 20.6 million/year could be saved if the AEs were reduced by 40%. 66