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S26-11
(P)
STRIVING FOR EXCELLENCE IN BLADDER EXSTROPHY CARE: WHAT DOES IT
COST TO COLLABORATE?
Dana WEISS
1
, Douglas CANNING
1
, Joseph BORER
2
, Evalynn VASQUEZ
2
, David DIAMOND
2
, Travis GROTH
3
, Aseem
SHUKLA
1
, John KRYGER
3
and Michael MITCHELL
3
1) The Children's Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA - 2) Boston Children's Hospital, Pediatric
Urology, Boston, USA - 3) Children's Hospital of Wisconsin, Pediatric Urology, Milwaukee, USA
PURPOSE
Successful primary closure is critical for optimal long-term results in children with bladder exstrophy. We developed the
Multi-Institutional Bladder Exstrophy Consortium (MIBEC), joining three institutions in order to improve the care of
children born with this rare defect. This effort increases each surgeon's experience and enhances learning by a collective
input of expertise. However, this commitment has required considerable investment in time and dollars.
MATERIAL AND METHODS
MIBEC teams travel to the host institution for observation and coaching during complete primary repair of bladder
exstrophy. Costs included: start-up, home and visitor travel, lodging and food, and opportunity. We defined the
opportunity cost (OC) per day, the amount that would have been generated as revenue if the surgeon was not traveling,
as annual collections of the surgeon/annual clinical days worked. Total OC = OC per day x work days spent in travel and
on-site observation.
RESULTS
Complete cost data was available for 20/23 site visits. The total cost of collaboration was $354,095 over 24 months.
This figure is the sum of $6,873 for startup costs, $24,303 for the hosting sites, and $22,773 for the visitors, plus OC's.
On average, each operating event cost $17,585, with $15,007 of that being OC. The most valuable commodity was
time, with total OC of $300,146.
CONCLUSIONS
Value in medicine has been defined as outcome divided by cost. Each MIBEC institution invested a significant sum
execute this collaborative experience. A future challenge will be to assess whether this investment leads to downstream
cost savings and improved outcomes.