Cost-Effectiveness of the National Surgical Quality Improvement Program (NSQIP)
Peter W. Dillon, MD, Melissa M. Boltz, MD*, Christopher S. Hollenbeak, MD*, Li Wang, MD*, Jane Schubart, MD*, Gail Ortenzi, MD*, Junjia Zhu, MD*
Penn State Milton S. Hershey Medical Center, Hershey, PA
The National Surgical Quality Improvement Program (NSQIP) has been extended to private sector hospitals since 1999, but little is known about its cost-effectiveness. The purpose of this study was to compare the cost-effectiveness of NSQIP at an academic medical center between the first six months, and through the first and second year of implementation.
Data included 2,229 general or vascular surgeries, 699 of which were conducted after NSQIP was in place for 6 months. We estimated an incremental cost-effectiveness ratio (ICER) comparing costs and benefits before and after adoption of NSQIP. Costs were estimated from the perspective of the hospital and included hospital costs for each admission, plus the total annual cost of program adoption and maintenance, including administrator salary, training, and IT costs. Effectiveness was defined as events avoided. Confidence intervals and a cost-effectiveness acceptability curve were computed using a set of 10,000 bootstrap replicates. Three time periods we compared were 1) 7/07-12/07 to 7/08-12/08, 2) 7/07-12/07 to 7/08-6/09, and 3) 7/07-6/08 to 7/08-6/09.
The incremental cost of the NSQIP program was $832, $876, and $266 for time periods 1, 2, and 3, respectively, yielding ICERs of $25,471, $19,878, and $7,319 per event avoided. The cost-effectiveness acceptability curves suggested a high probability that NSQIP was cost-effective at reasonable levels of willingness-to-pay (WTP).
In these data, not only did the NSQIP program appear cost-effective, but its cost-effectiveness improved with greater duration of participation in the program, resulting in a 28.7% decline of the initial cost.
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