Value-based healthcare e governance della chirurgia oncologica uterina. L’esperienza di un ospedale universitario.

[Autom. eng. transl.] Introduction Robotic surgery for malignant uterine tumors presents many clinical advantages (such as less blood loss and reduced probability of complications), but high costs, posing the problem of economic sustainability for healthcare facilities. The objective of this study was to carry out a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic and laparotomy surgery for uterine cancer in a university hospital. Materials and methods A retrospective observational study was conducted on hospitalizations for uterine cancer surgery between January 1, 2019 and October 31, 2021. DRG amount, costs, margins were calculated for robotic, laparoscopic and laparotomy surgery costs and percentage of readmissions at 30 days (mean values ​​and 95% CI). The analysis involved the application of Student's t tests and chi-square tests and the calculation of the breakeven point. Results 1336 hospitalizations were analysed, 366 with robotic surgery, 591 with laparoscopic surgery and 379 with laparotomy surgery. Robotic surgery showed a significant difference (p< 0.001) compared to laparoscopic and laparotomy for the economic margin, largely negative (-1069.18 €; 95% CI: -1240.44 -≤ -897, €92) mainly due to the cost of the devices (€3549.37; 95% CI €3459.32-3639.43), and a lower 30-day readmission rate (1.4%; 95% CI: 0. 2-2.6%) with a significant difference only compared to laparotomy (p = 0.029). Laparoscopic surgery showed a significantly (p< 0.001) more profitable economic margin compared to laparotomy (€1692.21; 95% CI: €1531.75-1852.66) without a significant difference for readmissions to 30 days. The break-even analysis showed that, on average, for each elective laparoscopic uterine cancer surgical procedure, 1.58 elective robotic surgeries are affordable for the hospital (95% CI: 1.23-2.06) . Conclusions The value-based approach to healthcare, defined as improving a patient's health outcomes relative to the cost of obtaining them, finds an effective application in uterine cancer surgery. The use of break-even analysis allows us to promote the value-based vision by identifying a useful criterion for planning and governing interventions for malignant uterine neoplasms. Its systematic application in the hospital context under consideration will allow us to define over time the right distribution of the volumes of robotic, laparoscopic and laparotomy surgeries to be performed in order to guarantee both the quality and the economic-financial balance and therefore the value of oncological surgery of the uterus.