Episode-based bundled payment model: evaluation of medical costs for early operable breast cancer

Introduction > Episode-based bundled payment model is actually opposing to fee-for-service model, intending to incentivize coordinated core. The aims of these study were to determine episode-based costs for surgery in early breast cancer patients and to propose a payment model. Methods > OPTISOINS01 was a multicenter prospective study including early breast cancer patients from diagnosis to one-year follow up. Direct medical costs, quality and patient reported outcomes were collected. Results > Data from 604 patients were analyzed. Episode-based costs for surgery were higher in case of: planned radical surgery (OR = 9,47 ; IC95 % [3,49-28,01]; P < 0,001), hospitalization during more than one night (OR = 6,73; IC95% [2,59-17,46]; P < 0,001), home hospitalization (OR = 11,07; IC95 % [3,01-173][3,01-54][3,01-543][3,01-54,33]; P < 0,001) and re-hospitalization (OR = 25,71; IC95 % [9,24-89,17; P < 0,001). The average cost was 5 268 (sic) [2 947-18 461] when a lumpectomy was planned and 7408 (sic) [4 222-22 565] in case of radical mastectomy. Bootstrap method was applied for internal validation of the cost model showing the reliability of the model with an area under the curve of 0,83 (95 % CI [0,80-0,86]). Care quality and patient reported outcomes were not related to the costs. Discussion > This is the first report of episode-based costs for breast cancer surgery. An external validation will be necessary to validate our payment model.