Budget Impact Model of Same-Day-Discharge Compared to Inpatient Bariatric Surgery in UK, Spain, and the Netherlands

OBJECTIVES: Several studies have shown that same-day-discharge (SDD) bariatric surgery can be performed as safe as inpatient surgery. The objective of this study is to compare the impact on economic outcomes and capacity of conducting SDD bariatric procedures versus inpatient surgery in the UK, Spain and the Netherlands considering each country’s unique reimbursement system. In the UK, bariatric surgery is reimbursed through a single national tariff, regardless of the setting. In the Netherlands, there are separate national tariffs for SDD and for inpatient setting; in Spain, hospitals are funded through a global budget.

METHODS: A model was developed to assess cost and capacity from the hospital’s perspective. Costs were calculated based on local length of stay (LoS) data for inpatient setting and a conservative assumption of 1-day LoS for SDD. The cost of one additional phone call for SDD as per a protocol conducted in a Dutch hospital was also included. It was assumed all other variables such as operating room (OR) time were unchanged. Capacity was assessed based on the different LoS between settings having a constant number of available beds.

RESULTS: In the UK and Spain, SDD could lead to savings of £285 and €578 per procedure, respectively. In the Netherlands, the reduction in LoS was associated with savings of €618 for SDD. However, the hospital received €740 lower revenue due to the difference in national tariff for each setting. However, as SDD reduces the LoS by half (1 vs 2 days), this translates into an increase in bed capacity that could lead to higher surgery volumes.

CONCLUSIONS: The results show that SDD bariatric surgery may be a cost-saving procedure compared to inpatient surgery from the hospital perspective in the UK and Spain. In all three countries, SDD lead to the increase in capacity due to the reduction in LoS.