The cost of thyroidectomy varies across the USA, while the causes of this variation are poorly understood. We examined the cost of inpatient thyroidectomy among National Cancer Institute-designated cancer centers nationwide to determine why it differs.
A retrospective study of inpatient thyroidectomies was performed using the Vizient Clinical Data Base. Fifty-two of 70 eligible hospitals were grouped into five geographic regions (Mid-Atlantic and New England, East Central, South Atlantic, West Central, and Mountain and Pacific). We identified drivers of cost variation in the five geographic regions and used risk adjustment model to evaluate the rationality of cost from each hospital.
Male sex, more extended hospital stays, and occurrence of complications were consistently associated with increased costs in all regions. Also, the cost was significantly lower in the Mid-Atlantic and New England region. The higher than expected costs did not correlate well with the case mix index among hospitals (p = 0.289), but the lower than expected costs were more common in high-volume hospitals. The average length of stay was the shortest in high-volume hospitals, which might account for the lower cost in the Mid-Atlantic and New England region; however, the overages of costs still varied widely among hospitals in all regions even if the length of stay was adjusted.
Cost variation may result from both patient-related factors and volume-related practice pattern differences among hospitals. A more standard of care and charge transparency is still needed for patients seeking affordable care at cancer centers.