# Clinical and economic impacts of a clinical pathway-based single disease payment policy on hysterectomy for uterine fibroids: a decade-long interrupted time series analysis

## TL;DR

A Chinese policy promoting cost-effective care for uterine fibroid surgeries reduced hospital costs and improved surgical methods over a decade.

## Contribution

This study evaluates the long-term clinical and economic effects of China's CP-SDP policy on hysterectomy for uterine fibroids using a decade-long ITS analysis.

## Key findings

- Laparoscopic surgery use increased significantly, reducing hospital stays and complications.
- Hospitalization expenses decreased, with a shift in cost structure favoring technical services over consumables.
- Out-of-pocket expenses dropped, while insurance reimbursement increased under the policy.

## Abstract

In 2017, China introduced clinical pathway-based single disease payment (CP-SDP) to curb healthcare costs, yet its impact is uncertain. Using uterine fibroids as a case, we evaluated its effectiveness.

We analyzed 4,727 hysterectomy cases for uterine fibroids from a tertiary hospital in Fujian Province between January 2014 and December 2023. Using an interrupted time series (ITS) with August 2017 as the intervention point, we fitted a segmented regression model to estimate immediate level changes and post-intervention trends. The impact of CP-SDP was evaluated across structure, process, and clinical outcome domains.

The utilization of laparoscopic surgery significantly increased from 45.1 to 75.5%, accompanied by 3.51 days reduction in average hospital stay. Significant changes had occurred in the cost structure: technical service fees (e.g., pathological diagnostics [+32.4%] and imaging [+7.3%]) increased, whereas consumable costs (e.g., antibacterial drugs [−48.5%] and disposable supplies [−19.5%]) decreased significantly. Hospitalization expenses decreased by 2.7%, while the postoperative complication rate decreased from 7.8 to 4.9%. ITS analysis showed that after the policy, hospitalization expenses immediately decreased by 2265.51 ¥ (13.28%) and continued to decrease. The long-term trend of out of pocket expenses had shifted from increasing to decreasing, and the proportion of medical insurance reimbursement had shifted from decreasing to increasing. In 2023, out-of-pocket expenses had reached their lowest level, whereas the reimbursement ratio had peaked.

CP-SDP appears to control costs while improving care quality by promoting minimally invasive procedures and optimizing cost allocation. This approach substantially reduces patients’ long-term financial burden.