In a study published online Wednesday in JAMA Surgery, researchers calculated that during 2009, six technologically advanced and minimally-invasive surgical procedures contributed a cost savings and workplace value of more than $11 billion, as well as the potential to contribute additional value of more than $3.1 billion among individuals with employer-sponsored health insurance.
According to study leader Andrew J. Epstein, research associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, he and his fellow researchers examined six types of surgery, including coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization and aortic aneurysm repair. They then compared health plan costs and workplace absence results for minimally-invasive surgical procedures against similar findings for standard, open surgical approaches.
Epstein said he focused on adults aged 18 to 64 years enrolled in employer-sponsored health insurance plans and assessed health plan expenditures for medical and pharmacy costs, as well as days absent from work, including vacation, sick leave and short-term disability. The team examined trends from a sample of 321,956 patients, of whom 23,814 were employees with available workplace absenteeism data.
The researchers found that minimally-invasive procedures for three of the six surgeries resulted in significantly lower health plan spending, and four resulted in significantly fewer days of work absence. After accounting for patients' healthcare spending and absenteeism in the year prior to surgery, the most dramatic health plan spending differences and days absent were for minimally-invasive coronary revascularization (–$30,850 and 37.7 fewer days per procedure).
"We were interested at looking at minimally-invasive surgeries and their impact on healthcare spending and workplace absenteeism. We saw a gap in the research here along with discussions of what value really means in medical care,' said Epstein. "Clinical outcomes are obviously important, but they shouldn't be the sole measure of potential benefit. Recovery times also matter. How quickly people can get back to work, and the effects on their employers' bottom lines, are both real and important factors for assessing value."
Based on findings for the procedures in the study and using 2009 population and cost figures, Epstein calculated a national reduction of $8.9 billion in health plan spending and 53,134 person-years in worker absenteeism, worth an estimated additional $2.2 billion. If minimally-invasive surgery had been used for all patients undergoing the six procedures in 2009, the sum of the effects would exceed $14 billion, 22 percent of which would have come from reductions in worker absenteeism, he said.
"The study indicates that payers ought to be thinking about the economic value of workplace productivity strategies," Epstein said.
He added that these technologically advanced surgeries are another important factor when considering how to define better care for patients at lower costs.