Cost of referral treatment for colic in the United Kingdom-What has changed in the last 5 years?

Abstract

BACKGROUND: Referral treatment costs and insurance status impact treatment decisions for colic. OBJECTIVES: To evaluate changes in the cost of referral treatment for colic, and insurance cover and premiums in the United Kingdom between 2018 and 2023. STUDY DESIGN: Cross sectional study. METHODS: Thirty UK equine referral hospitals were contacted in January 2024 and asked about their colic caseload and costs of the last three cases across six categories (surgical +/- resection, euthanasia before, during or after surgery, and medical treatment), using similar methodology to a 2018 study. Data are reported as mean/median (range). A standardised case was used to retrieve data on veterinary fees, insurance cover, and monthly premiums from five companies. Findings were compared with actual and inflation-adjusted 2018 data. Readability of insurance documents were assessed using the Flesch Kincaid Reading Ease (FKRE) score and the Gunning Fog Score (GFS). The FKRE is ranked from 0 to 100 (easy to read-hard to read); FKRE scores below are 65 recommended. The GFS estimates the years of formal education needed to understand text; GFS scores higher than 12 are too complex for most people to read. RESULTS: Eighteen hospitals responded, contributing costings for 248 cases in total. Mean/median (range) costs for cases euthanised without surgery (n = 41) were £1200 (£500-£4389), for medical cases (n = 44) were £2379 (£683-£13,762), and for all surgical cases that survived surgery (n = 122) were £7905 (£3023-£20,343). When compared with inflation-adjusted 2018 data, medical treatment and euthanasia without surgery costs had increased; surgery costs had decreased. Maximum insurance cover was between £5000 and £7500. The actual cover value had not changed for 3/5 companies since 2018, and was reduced for 4/5 companies after inflation adjustment. Monthly premiums ranged from £42.76 to £97.23, and were all increased compared with 2018 inflation-adjusted data (£34.01-£59.39). Insurance document FKRE Scores ranged from 31.2 to 54.8, and GFS ranged from 13.6 to 20.6. All were outside the recommended range. MAIN LIMITATIONS: Small case numbers, UK population only. CONCLUSIONS: Costs of referral treatment have largely risen in line with inflation, and now frequently exceed maximum insurance cover. Insurance premiums have increased above inflation, and insurance documents remain complex and hard to read.