PAIR. A preliminary evaluation of cost in Italy

There is no consensus as to what is the best treatment (surgery, chemotherapy and percutaneous treatments) for hepatic cystic echinococcosis (CE). Retrospective studies have addressed the pros and cons of each option, but costs of treatments, an important issue particularly in developing countries, have never been studied extensively. Aim of this paper is to calculate the cost of PAIR for non-complicated echinococcal cysts of the liver in Italy. Costs of hospital stay, of disposable items, salaries for health personnel and sonograms, were obtained from the S.Matteo Hospital Administration and pharmacy. The institution is a large tertiary care teaching hospital in Lombardy, a region in Northern Italy. Costs of 1 year follow-up were included. The costs were calculated with respect of a 3-day hospital stay without complications. The 2006 mean specific cost of a PAIR treatment for a 3 day hospital stay and 1 year follow-up was 2,072 EUR (average exchange rate : 1 EUR = 1.26 USD). Main cost entries were the following: a) days spent in hospital (net cost of stay): € 1,500 (72.4% of the total cost); b) disposable items (needles, catheters) € 239 (11.5%); c) personnel : € 156 (7.5%); d) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (3.5%); e) imaging examinations (paid by patient): € 105 (5.1%). PAIR is a relatively inexpensive treatment for uncomplicated cysts. The hospital stay accounts for the bulk of the costs. Further research is needed to compare the costs of PAIR with those of surgery (radical and conservative). This would contribute important information to the debate on the best treatment for liver CE.