Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting.
A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques.
Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy.
Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.
Endoscopic ear surgery is a relatively new technique that can be performed totally transcanal, using angled objective lenses to view areas that require soft tissue manipulation and bony drilling with the microscope.1 One of the cornerstone indications for endoscopic ear surgery lies in the management of mesotympanic and attic cholesteatoma.2,3 The technique has been shown to be as safe and efficacious as open approaches, with similar residual or recurrent cholesteatoma rates reported in the limited case series reviewed to date.4 Beyond safety and efficacy, when new surgical techniques are introduced, continual justification and rationalisation of expenditure are needed, as healthcare operates in a resource-limited environment. Whilst health gains that occur with improvements in technology often come at significant expense, it would be ideal if these gains were achievable at minimal cost or even with savings.
Complete analysis of the monetary value of a healthcare intervention occurs through examination of direct, indirect and future costs. Direct costs, such as surgical, anaesthetic, hospital and equipment costs, can be identified, and as a result are amenable to analysis. Indirect and future costs, such as faster discharge and return to work, and increased productivity, are more challenging to analyse, and critically require an analysis of quality of life.
From a hospital’s perspective, when a new technique is being considered, the capital investment required often delays implementation. For this reason, the initial and ongoing direct costs of the new technique to the hospital are of importance to justify implementation. In the following analysis, the direct costs of totally endoscopic ear surgery from a private hospital perspective are compared to open surgery. Indirect and opportunity costs are excluded from this analysis. The null hypothesis of this study was that the totally endoscopic and open techniques have a similar direct cost to the hospital.