Cost-Effectiveness Analysis of Perioperative Oral Management after Cancer Surgery and an Examination of the Reduction in Medical Costs Thereafter: A Multicenter Study

Abstract

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.

Dental and oral management in the perioperative period of surgery: A scoping review

“…Eight studies were obtained that examined a combination of various types of surgery (two SRs and six observational studies) [2] , [3] , [4] , [5] , [6] , [34] , [35] , [36] . An SR by Liang et al [2] examined the effect of nurse-led perioperative chlorhexidine oral care and dental professional-led perioperative oral care on postoperative pneumonia and postoperative mortality in surgical patients, excluding cardiac patients.…”

“…Six observational studies compared the patients with and without perioperative oral management, four of which analyzed big data from national health insurance databases. Five studies examined the effect on postoperative pneumonia, four [3] , [4] , [6] , [36] reported significant preventive effect, and one [17] reported no significant effect (all with low risk of bias). Additionally, Ishimaru et al [6] reported that preoperative oral care by a dentist was significantly associated with a decrease in all-cause mortality within 30 days of surgery (low risk of bias).…”

Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan

“…In patients with diseases where poor oral hygiene is prevalent, such as head and neck cancers, as well as cerebrovascular disease, where oral microbiota can significantly influence outcome, the importance of oral care has been particularly emphasized [49][50][51] , with those reports indicating that an effective oral care strategy for patients with these conditions is crucial. Additionally, a multicenter study found that perioperative oral care during cancer treatment reduces hospitalization costs 52 . However, despite use of appropriate oral care, postoperative pneumonia has been reported to occur in various types of cancer cases 6,53 .…”

Sensitivity and specificity of the question “do you have any concerns regarding your mouth related to undergoing surgery?” for predicting perioperative oral health problems in patients with primary esophageal and lung cancer: a retrospective observational study

“…Patients who answer “yes” to this question in a hospital without a dentist should be consulted by an outside dental institution to resolve the problem if permitted by their general condition and surgical schedule. The universal health insurance system in Japan covers oral management at community dental institutions before surgery (Sekiya et al 2021 ).…”