A Costed Profile Audit of the Surgical Management of Female Stress Incontinence

Abstract

Background and aims: To conduct a profile audit of three surgical treatments for urinary stress incontinence through the application of an episode costing process. Methods: Four stage methodology: (1) construction or a profile of care for each of the surgical approaches (setting the standard); 2) calculation of a theoretical profile cost; (3) calculation of the observed costs from real patient episodes; (4) comparison of observed costs with profile costs, (comparing present practice with established standard). Results: Profiles of care were constructed and compared with 39 actual in~patient episodes. Tension free vaginal tape (TVT™ Gynecare) is the cheapest modality of treatment in terms of both the expected profile cost and also observed (real patient) cost. Colposuspension is the most expensive form of treatment with real costs significantly greater than the expected profile. Clinical issues such as length of stay, duration of surgery, patient selection and complication rates were revealed through the exception reporting process. Length of stay is the main determinant of overall cost. Conclusion: It is possible to construct a costed and auditable standard of care for a surgical procedure. This standard can be compared with real patient costs calculated using the same methodology. Exception reporting based on differences between expected and real costs can be used to facilitate the audit of clinical practice. The technique is limited, however, by the need to collect accurate and detailed activity data.