Letter to the Editor

JOURNAL OF GYNECOLOGIC SURGERYMary Ann Liebert, Inc., Publishers

The Most Expensive Hysterectomy

In his editorial "The Most Expensive Hysterectomy," which appeared in Volume 8, 1992, page 57, Dr.Baggish catalogued a list of disposable apparatus used for laparoscopic hysterectomy to bolster his

argument that any savings of cost in reduced hospital stay was more than offset by the cost of thisinstrumentation. At the top of the list was an irrigating cannula that was stated as costing as low as $95.00 andas high as $ 135.00. First, the irrigating cannula that is used by the majority of laparoscopists costs the hospital$65.00. The numbers quoted by Dr. Baggish are not specified with respect to whether this is a cost to thehospital or a cost to the patient. In researching this I have found what I believe are excessive markups by thehospitals in this area. Prices of items are sometimes more than doubled since the insurance carriers, at least atthe present time, appear to have swallowed these costs without question. Perhaps the hospitals see this as a

way to make up on revenue lost by empty beds. Certainly, inventory does not go out of style as clothing does,and does not spoil on the shelf as food would. In addition, hospitals can send any item that does not functioncompletely to satisfaction back to the manufacturer for a full credit. Therefore, the losses incurred throughinventory should be very low.

With respect to the irrigators in particular, it is true that nurses find the process of cleaning these out betweencases distasteful, and I think this is at least one item that, because of its low cost, makes good sense,particularly if one were to cost account the actual expense of cleaning, reassembling, and sterilization. Withrespect to the other items, there may be honest room for differences of opinion, but I believe that the hospital'srole in the pricing structure should be scrutinized more carefully.

Stephen L. Corson, M.D.Clinical Professor, Department of OBIGYN

University of Pennsylvania School of MedicineSection Head, Reproductive Endocrinology

Pennsylvania HospitalPhiladelphia, Pennsylvania

ResponseI wish to thank Dr. Corson for this thoughtful letter regarding the use of disposable instruments and hospitalsurcharges.

In researching material for the editorial, I compiled a list based upon average costs of disposables garneredby me from several instrument manufacturers. The actual cost to the hospital was very difficult information toobtain. It reminded me of trying to fathom the dealer's cost of a new car. Some of the factors included: (1) Thevolume of the purchase, (2) how many disposable trocars were purchased, and (3) whether an institutionsolely purchased from one manufacturer. I really couldn't begin to understand what relationship existsbetween the cost of irrigating cannulas and the number of trocars a hospital contracts to buy.

It does not surprise me that hospitals will further inflate the cost of disposables. I believe all hospitals willadd a surcharge for any disposable items whether they be bandages, pills, or laparoscopic instruments. This issimply the middle-man charge-up. Most hospitals however will not add a charge for the use of reusableinstruments.

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