Imperial College London
Dr Alexander Carter

DrAlexanderCarter

Faculty of Medicine, Department of Surgery & Cancer

Honorary Senior Lecturer
 
 
 
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Contact

 

a.w.carter

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Sabharwal:2016:10.1302/0301-620X.98B2.36255,
author = {Sabharwal, S and Carter, AW and Rashid, A and Darzi, A and Reilly, P and Gupte, CM},
doi = {10.1302/0301-620X.98B2.36255},
journal = {Bone & Joint Journal},
pages = {249--259},
title = {Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff},
url = {http://dx.doi.org/10.1302/0301-620X.98B2.36255},
volume = {98B},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Aims The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.Methods A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of costResults The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of incomeDiscussion Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs.Take home message: This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned.
AU  - Sabharwal,S
AU  - Carter,AW
AU  - Rashid,A
AU  - Darzi,A
AU  - Reilly,P
AU  - Gupte,CM
DO  - 10.1302/0301-620X.98B2.36255
EP  - 259
PY  - 2016///
SN  - 2049-4394
SP  - 249
TI  - Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff
T2  - Bone & Joint Journal
UR  - http://dx.doi.org/10.1302/0301-620X.98B2.36255
UR  - http://hdl.handle.net/10044/1/32602
VL  - 98B
ER  -
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