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Activity-based funding (ABF) is a reimbursement model for public hospitals in Ireland. Little data exist regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct cost estimation for testicular torsion (TT) care in Ireland. Hospital Inpatient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009 and 2018. The monetary cost of each case was calculated by cross-referencing the diagnosis-related group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland). One thousand seven hundred forty-six patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1230) were reimbursed with public funding. This novel cost estimation model may serve as a template for future direct cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland., (© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: The estimated incidence of testicular torsion (TT) is 4 per 100,000 males under 25 years [1]. Age, region and health insurance status have been associated with a higher risk of orchidectomy following TT [2]., Aims: This study aimed to establish incidence rates for TT in Ireland for the first time. Sociodemographic characteristics were analysed to assess risk factors for undergoing orchidectomy., Methods: A retrospective analysis of a national database, Hospital In-Patient Enquiry (HIPE), was carried out. Cases of TT treated between 2009 and 2018 were identified. Incidence and age-specific rates were calculated in conjunction with census data. Descriptive statistics, non-parametric tests and logistic regression were used to evaluate risk factors for orchidectomy., Results: Between 2009 and 2018, 1746 males under 25 years underwent scrotal exploration for TT. The crude incidence was 21.76 per 100,000 population. The age-standardised rate rose from 16.85 per 100,000 in 2009 to 26.31 per 100,000 in 2018. TT was most common in the 10-14 years age-group (n = 766, 43%) with a normal distribution across age-groups. TT most commonly occurred in spring (27.55%, 95% CI 25.46-29.71%), and was least common in summer (21.65%, 95% CI 19.46-23.36%, p < 0.01). Age, lack of private insurance, province of residence and transfer from another hospital were associated with orchidectomy., Conclusions: The incidence of TT appears to be higher in Ireland than elsewhere. Epidemiological data for TT in Ireland will help inform health policy and clinical guidelines, facilitate comparison with other jurisdictions and improve public awareness. Further research is needed to identify modifiable risk factors that predict treatment outcomes., (© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)