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Introduction: While higher radical prostatectomy (RP) hospital and surgeon volume is associated with better outcomes, the effect of provider volume on healthcare costs remains unclear.
Materials & Methods: We used SEER-Medicare data to identify 5,964 men who underwent RP from 2003-2005. We categorized hospital and surgeon RP volume during the study period into quartiles (low, intermediate, high, very high). Costs from inpatient, outpatient, and physician services were assessed from RP until 90 days postoperatively.
Results: Higher surgeon volume was associated with lower RP costs (low \,925; intermediate \,680; high \,649; very high \,384, p<0.001) while higher hospital volume was associated with greater costs (low \,910; intermediate \,006; high \,696; very high \,132, p<0.001). In adjusted analyses, the cost savings of an additional RP by surgeon volume was \.6 (95% CI: 4.4-16.8, p<0.001) while the marginal cost for an additional RP by hospital volume was \.8 (95% CI: 4.1-9.6, p<0.001). Moreover, RP costs were higher for single vs. married men (\.9, 95% CI: 138.4-629.4, p=0.002) and Black (\.0, 95% CI: 296.7-901.3, p<0.001) and Hispanic (\.9; 95% CI: 65.8-936.1, p = 0.024) vs. white men. Finally, there was significant geographic variation, and the RP cost differential between the most and least costly SEER regions was \.4 (95% CI: 3361.6-4615.2, p<0.001)
Conclusions: Higher RP surgeon volume leads to significant savings; however, higher RP hospital volume increased costs. These findings should be considered when balancing health care reform initiatives to improve quality while reducing health care expenditures.