The results of care and cost of treatment in thyroid nodules at Sunprasitthiprasong Hospital, Ubon Ratchathani Province

Abstract

Thyroid nodules are prevalent in North-eastern part of Thailand due to iodine insufficiency. Sunprasitthiprasong Hospital in Ubon Ratchathani province is a tertiary hospital in the North-east has been treating a large number of patients with thyroid nodule each year by following the clinical practice guidelines of the Royal College of Otolaryngology of Thailand. At present, the cost of medical services trends to be increasing continuously every year. On the other hand, the government needs to limit the budget of medical services. In Thailand, the National Health Security Organization initiates some policies to control Medical expenses by allocating medical reimbursement in the form of Relative Weight (RW) and Diagnosis Related Groups (DRGs) for the Inpatient service. This study was conducted to review of our patients with thyroid nodules who were treated by thyroid surgery from October 2011 to September 2012. The objectives are to study cytologic results from fine needle aspiration (FNA) of the thyroid glands. And this study also performed activity-based costing (ABC) analyses (labour costs, material costs and captital costs) compared to the value of reimbursement paid by our government. This study enrolled 240 patients. The mean age was 46.77 ± 0.76 years, female 93.33%. One hundred and sixty three patients (67.92%) 
underwent FNA before surgery. Cytologic study revealed 78.53% to be benign, 13.49% found to be follicular lesion, 1.23% found to be malignancy and 6.75% found to be unsatisfied due to inadequate biopsy specimen. 63.75% of the cases received lobectomy, 10% had partial thyroidectomy, and 26.25% total/near total thyroidectomy. Pathological data from 239 patients were available. 87.03% were found to be benign, 12.97% found to be malignant. When compare the cost of thyroid surgery to the value of reimbursement from the government (DRG), this study found that the unit cost is less than reimbursement compensation for two types of operations which consist of lobectomy and partial thyroidectomy (unit cost for lobectomy is 13,301.42 baht and 14,500.78 baht for partial thyroidectomy compared to 14,816.80 baht reimbursement for both kinds of operation). On the contrary, the unit cost of total/near total thyroidectomy is greater than the government reimbursement (21,136.23 baht for unit cost compared to 14,816,80 baht for government reimbursement).