COST-ANALYSIS OF 3 DIFFERENT SURGICAL-PROCEDURES FOR TREATMENT OF A PELVIC TUMOR

Introduction: Malignant pelvic tumours are rare, but adequate treatmen t is difficult because of anatomical and functional reasons. Different surgical procedures are recommended. Besides aspects influencing the quality of lift: due to the different surgical techniques, costs of th ese surgical procedures and the perioperative time interval, depending on the chosen surgical procedure, must also be considered. Methods: C osts of three kinds of surgical treatment - internal hemipelvectomy vs external hemipelvectomy and application of an orthotic device vs ilio -femoral pseudoarthrosis - were compared, including costs of the immed iate period of rehabilitation. Costs of the preoperative diagnostic pr ocedure were excluded because they were assumed to be equal. For all c alculations, treatment of a periacetabular pelvic tumour type II-b was assumed, according to the Enneking classification, with the need for a pelvic resection with wide margins including removal of the hip join t. This analysis was performed based on the average costs per hour of physicians, nurses and physiotherapists, including a basic daily rate for additional costs, such as housekeeping and administrative costs of the hospital. In all cases, the costs of the operative procedure and the perioperative period up to 3 months were calculated, including the costs for the endoprosthetic device after internal hemipelvectomy and those for the orthotic devices after necessary external hemipelvectom y. Results: For a postoperative period of 3 months, the cost for treat ment with resection of the tumour and performing an ilio-femoral pseud oarthrosis is nearly DM 56,741.54; treatment with an internal hemipelv ectomy including the endoprosthetic pelvic replacement costs DM 81,439 .34; and treatment with external hemipelvectomy and application of an orthotic device with a pelvic cage costs DM 69,138.46. In this analysi s, social costs due to the different rates of disability for years or costs of a new prosthetic device after years and aspects related to re sulting quality of life were excluded. In contrast, costs of three dif ferent actual cases can differ significantly from the estimated costs. The most important influencing items are surgical implants, blood uni ts and similar products, and surgical treatment of postoperative compl ications. Conclusions: Regarding all these aspects, limb salvage seems to be advantageous over amputation. Whether an ileo-femoral pseudoart hrosis or endoprosthetic pelvic replacement should be performed is a d ecision that should be made by the physicians, based on the underlying diagnosis and the correlated expected survival. Furthermore, addition al factors probably reducing the rate of postoperative complications, such as infections or necrosis following radiotherapy and being summar ised under the term ''quality of life'', should also be regarded.