Cost outcomes
Tables 2 and 3 show the primary outcomes of the study from the
service-provider perspective.
The
mean total cost per patient of the
Tertiary Unit was
moderately
higher than that of the Secondary
Unit but the difference was not statistically significant
(\euro577.5
± \euro219.6 vs. \euro394.7 ±
The
mean cost per visit of both units was quite similar
(\euro182.8 ± \euro41.47 in
the Tertiary vs. \euro184.6 ±
Unit; P =0. 0.9056). An analysis of general costs revealed that
direct and structural costs per patient of the two units were not
significantly different. Conversely,
indirect
costs of the Tertiary Unit were significantly higher than those of the
secondary center unit
(\euro49.93 ± \euro19.90 vs.
\euro12.42 ± \euro2.344,
respectively; P =0.0018) (Table 2).
An individual assessment of the
five single components of direct costs showed that
personnel costs
were significantly higher in the
Tertiary (\euro68.75 ± \euro14.90) than in
the Secondary Unit (\euro36.90 ±
costs were slightly but nonsignificantly higher in the former
(\euro197.6 ± \euro111.6 vs.
direct cost components, namely
imaging and endoscopy, biopsy and cytology techniques, and specialist
consultation and referral were not significantly different
(Table
3).
We further calculated
the percentage contribution of
each cost component to
the mean cost per patient. In both
units, direct costs accounted for the largest proportion of
cost per patient without
significant differences (79.13 percent [95% confidence interval,
77.12-81.14] in the Tertiary vs. 81.15 percent [77.53-84.76] in
the Secondary Unit; P =0.3327). However, the percentage
contribution of indirect costs to the mean cost per patient was
significantly higher in the unit
of the tertiary center (8.595 [8.377-8.813] vs. 3.284 percent
[2.618-3.950], respectively; P <0.0001) (Table 2).
When looking at the rate of sharing of each fraction of direct costs in
the mean cost per patient,
laboratory and pathology and
imaging and endoscopy costs
accounted for the largest amount, with a significantly higher percentage
contribution of imaging and endoscopy costs in the secondary vs.
tertiary center unit. Whereas costs of biopsy and cytology techniques
and specialist consultation and referral accounted for a tiny fraction
of the cost per patient in both units without relevant differences, the
average contribution of personnel costs was significantly higher in the
Tertiary compared to the Secondary Unit (12.58 percent [10.64-14.51]
vs. 9.746 percent
[8.029-11.46], respectively;P =0.0373) (Table 3).
We also examined the relevant costs of patients from both units
according to clinical data (Tables
4 and 5). Patients referred for symptoms suggestive of cancer and those
with a final diagnosis of cancer
were more often referred from the emergency department
to the unit of the tertiary center
and from primary care centers to the Secondary Unit
(P <0.0001 in both cases). For patients referred for
symptoms suggestive of cancer, no significant differences were observed
in the mean cost per patient
between
the Tertiary and the Secondary
Unit (\euro782.52 ±P =0.0537) (Table 4). Likewise, there were no significant
differences in the cost per
patient between the Tertiary and the Secondary Unit with regard to a
final diagnosis of malignancy
(\euro1,069.17 ± \euro218.64
vs. \euro827.65 ± \euro151.83, respectively; P =0.0871) (Table
5). Consistent with the results of the main analysis, cost differences
continued to lie in personnel and indirect costs both for
patients
referred for symptoms suggestive of cancer
(Table 4) and for patients with a
final diagnosis of cancer (Table 5).