Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy

Abstract

Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach.

Figure 1.

Ultrasound classification and stage-specific approach to cystic echinococcosis (CE) cysts according to the World Health Organization Informal Working Group on Echinococcosis Expert Consensus modified from Rinaldi and others, 2014. ABZ = albendazole; PAIR = puncture, aspiration, injection, reaspiration.

Figure 2.

Distribution of hospitalization and surgical intervention-related costs for each patient in decreasing order of cost. Administrative = administrative costs, fixed at the 20% of the total cost; hospitalization = cost per day × length of hospital stay; total intervention = cost of surgical intervention; total procedures = cost of all examinations performed during the hospital stay.