Outpatient Paracentesis Cuts Costs for OHSS


SAN FRANCISCO — Outpatient paracentesis is one-fifth the cost of hospitalization for managing ovarian hyperstimulation syndrome.

The total direct cost (2007 estimates) would be $10,098 for inpatient therapy including first-tier complications, compared with $1,954 for outpatient management, Dr. Joelle E. Taylor reported at the annual meeting of the American Society for Reproductive Medicine.

The finding is based on a decision-tree analysis derived from outcome probabilities and outpatient management effectiveness data from the published literature and from a retrospective chart study.

For the analysis, conservative inpatient treatment was compared with outpatient paracentesis in patients with moderate to severe ovarian hyperstimulation syndrome (OHSS)—a syndrome that occurs in up to 5% of assisted reproductive technology cycles and has potentially severe complications such as thromboembolism and respiratory distress syndrome.

“Early intervention and outpatient management translated into a cost savings of more than $8,100 per patient,” said Dr. Taylor, who was a visiting resident at the National Institute of Child Health and Human Development, Bethesda, Md., at the time the study was conducted. Currently, Dr. Taylor is an ob.gyn. at Wake Forest University, Winston-Salem, N.C.

Even after varying the probability of admission following outpatient treatment, outpatient paracentesis remained the most cost-effective treatment strategy, and varying the duration of hospitalization showed that inpatient and outpatient treatment costs were comparable only when the hospital stay was 0.71 days or less, Dr. Taylor noted.

Furthermore, if every patient with OHSS who was managed on an outpatient basis required three paracenteses to resolve the syndrome, the outpatient treatment cost increased by less than $900 (to $2,851)—still a marked reduction compared with the cost of inpatient therapy, Dr. Taylor said.

“The cost savings [with outpatient paracentesis] persisted despite a variety of outcome probabilities and treatment scenarios,” she said.

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