The value of uterine oncological surgery in a University Hospital. Results of a break-even analysis

Background

Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital.

Methods

An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated.

Results

1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 € - 1852.66 €) without a significant difference for 30-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06).

Conclusions

The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital.

Key messages

• The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery.

• The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.

Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic

Background

During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era.

Methods

The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting.

Results

A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic.

Conclusions

The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats.

Key messages

• Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions.

• In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on soft skills and management competencies should be recommended.

Personalised Medicine in shaping sustainable healthcare: a Delphi survey within the IC2PerMed project

Background

Personalised medicine (PM) has the potential to transform health systems and make them more sustainable, by making the population healthier and allocating resources efficiently. European Union and China have become world leaders in the field of PM, increasing collaborations worldwide. In this context, the EU Commission in 2020 launched the IC2PerMed (Integrating China in the International Consortium for Personalised Medicine) project to provide key solutions to enable the convergence of European and Chinese stakeholders toward a common approach in PM.

Methods

From a mapping exercise of policies and programs in PM in EU and China, we identified 20 priority items for shaping sustainable healthcare. Such items were submitted to several Chinese and European experts in PM involved in a 3-round Delphi survey. Experts were asked to review the items’ content and rate their validity and relevance on a 5-point Likert scale. Priorities reaching a Content Validity Index of more than 79% were included, between 70 and 79% were revised, and less than 70% were excluded.

Results

Of 20 priorities submitted, 9 reached consensus. The priorities hinge on the resources allocation, defining in advance priority investment, and identifying new payment models for public reimbursement, health technology impact, and assessment importance, while integrating end-user perceptions into the whole innovation process. In addition, the pivotal role of multidisciplinary and cross-sectorial collaborations emerged. Ethical, legal, and social implications and the related costs should be always considered in policymaking, evaluation, and management of technological innovation.

Conclusions

Integrating resources and setting a clear agenda for the implementation of PM would lead to a faster and more efficient translation into clinical practice. Developing policies valuing all the stakeholders’ contributions would implement PM adoption.

Key messages

• Healthcare systems sustainability is a priority and PM could make the population healthier and help allocate resources more efficiently, hence reducing the overall costs of healthcare.

• The inter-sectoral collaborations in healthcare are fundamental to achieving the best standard of care. All stakeholders and policymakers should engage to foster sustainability.