Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis

Scheuter, Claudia; Wertli, Maria M.; Haynes, Alan G.; Panczak, Radoslaw; Perrier, Arnaud; Rodondi, Nicolas; Aujesky, Drahomir

doi:10.1371/journal.pone.0208578

Cited by 17 publications

(22 citation statements)

References 38 publications

(48 reference statements)

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“…For instance, residents of Swiss Romance language regions were shown to consult specialists more frequently [50] and to have higher per-capita healthcare costs [52] than residents in Swiss German language regions. However, our results and others suggest that the higher healthcare use in Romance language regions may not necessarily extend to elective invasive procedures, such as gynecological and orthopedic interventions [14]. Interestingly, the lower hysterectomy rates among Romance-speaking HSAs appear to be driven by a lower rate of vaginal procedures, with slightly higher rates of abdominal and laparoscopic hysterectomy compared to Swiss German HSAs.…”

Section: Plos Onecontrasting

confidence: 50%

“…A population-based, small area analysis based on routinely collected patient discharge data from all public and private Swiss acute care hospitals and census data was conducted for calendar years 2013-2016 [14]. Swiss hospitals are legally obligated to provide the Swiss Federal Statistical Office (SFSO) with an anonymized, standardized data set for each hospital discharge.…”

Section: Data Sourcesmentioning

confidence: 99%

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Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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Background Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation. Methods We conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists. Results Overall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186-456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates.

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Section: Plos Onecontrasting

confidence: 50%

Section: Data Sourcesmentioning

confidence: 99%

Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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“…Finally, most studies assessed the variation in utilization of a single service, or one category of services (e.g. related surgical procedures) [ 8 , 9 ]. More comprehensive studies simultaneously comparing a wider range of services are currently missing.…”

Section: Introductionmentioning

confidence: 99%

Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study

Wei

Ulytė

Gruebner

et al. 2020

BMC Health Serv Res

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Background Regional variation in healthcare utilization could reflect unequal access to care, which may lead to detrimental consequences to quality of care and costs. The aims of this study were to a) describe the degree of regional variation in utilization of 24 diverse healthcare services in eligible populations in Switzerland, and b) identify potential drivers, especially health insurance-related factors, and explore the consistency of their effects across the services. Methods We conducted a cross-sectional study using health insurance claims data for the year of 2014. The studied 24 healthcare services were predominantly outpatient services, ranging from screening to secondary prevention. For each service, a target population was identified based on applicable clinical recommendations, and outcome variable was the use of the service. Possible influencing factors included patients’ socio-demographics, health insurance-related and clinical characteristics. For each service, we performed a comprehensive methodological approach including small area variation analysis, spatial autocorrelation analysis, and multilevel multivariable modelling using 106 mobilité spaciale regions as the higher level. We further calculated the median odds ratio in model residuals to assess the unexplained regional variation. Results Unadjusted utilization rates varied considerably across the 24 healthcare services, ranging from 3.5% (osteoporosis screening) to 76.1% (recommended thyroid disease screening sequence). The effects of health insurance-related characteristics were mostly consistent. A higher annual deductible level was mostly associated with lower utilization. Supplementary insurance, supplementary hospital insurance and having chosen a managed care model were associated with higher utilization of most services. Managed care models showed a tendency towards more recommended care. After adjusting for multiple influencing factors, the unexplained regional variation was generally small across the 24 services, with all MORs below 1.5. Conclusions The observed utilization rates seemed suboptimal for many of the selected services. For all of them, the unexplained regional variation was relatively small. Our findings confirmed the importance and consistency of effects of health insurance-related factors, indicating that healthcare utilization might be further optimized through adjustment of insurance scheme designs. Our comprehensive approach aids in the identification of regional variation and influencing factors of healthcare services use in Switzerland as well as comparable settings worldwide.

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“…French/Italian speaking areas had a 21% lower prostate surgery rate than Swiss German language regions, possibly due to more conservative physician practice styles or patient preferences for less invasive treatments. We previously have observed lower rates of other preference-sensitive surgical interventions in the French/Italian speaking parts of Switzerland, including vertebroplasty, hysterectomy and joint replacement [19,55,56]. We found no association between semi-/private insurance and prostatectomy rates, arguing against the suspicion that a semi-/private insurance (which results in higher physician fees) may fuel overtreatment in Switzerland.…”

Section: Plos Onementioning

confidence: 54%

High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland

et al. 2021

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Background Among various treatment options for benign prostatic hyperplasia (BPH), surgical therapy is the most invasive. As Switzerland has the highest transurethral prostatectomy rate among OECD countries, we assessed the regional variation in prostate surgery for BPH and explored potential determinants of variation. Methods We conducted a population-based analysis using discharge data for men aged ≥40 years with transurethral or simple prostatectomy from all Swiss hospitals during 2013–2018. After excluding patients with genitourinary/prostate cancer, we derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). We estimated the reduction in variance across HSAs of prostatectomy rates in multilevel regression models, with incremental adjustment for age, regional cultural and socioeconomic factors, disease burden, density of urologists, and the time since urologists’ graduation. Results Overall, 44,253 prostatectomies (42,710 transurethral and 1543 simple) from 44 HSAs were analyzed. The mean age-standardized prostate surgery rate was 314 (range 166–500) per 100,000 men aged ≥40 years per year. The EQ was 3.01 and the SCV 5.53, indicating a high regional variation. In multivariate models, men aged 75–79 years had an 11.6-fold higher prostatectomy rate than those aged 50–54 years. French/Italian language areas had a 21% lower rate than Swiss German speaking areas. Socioeconomic factors, disease burden, and density of urologist/time since graduation were not associated with prostatectomy rates. After full adjustment, 80% of the variance in prostate surgery across HSAs remained unexplained. Conclusion We found a remarkably high regional variation in prostate surgery rates for BPH within Switzerland.

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Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis

Cited by 17 publications

References 38 publications

Regional variation of hysterectomy for benign uterine diseases in Switzerland

Regional variation of hysterectomy for benign uterine diseases in Switzerland

Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study

High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland

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