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Surg Endosc. 2018 Dec;32(12):4912-4922. doi: 10.1007/s00464-018-6250-9. Epub 2018 Jun 4.

Cost-effectiveness analysis of laparoscopic versus open surgery in colon cancer.

Author information

1
Unidad de Investigación AP-OSIs Gipuzkoa, Hospital Alto Deba, Mondragón, Spain. javier.marmedina@osakidetza.eus.
2
Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain. javier.marmedina@osakidetza.eus.
3
Biodonostia Health Research Institute, Donostia-San Sebastián, Spain. javier.marmedina@osakidetza.eus.
4
Unidad de Gestión Sanitaria, Hospital 'Alto Deba', Avenida Navarra 16, 20500, Mondragón, Spain. javier.marmedina@osakidetza.eus.
5
Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
6
Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
7
Unidad de Investigación AP-OSIs Gipuzkoa, Hospital Alto Deba, Mondragón, Spain.
8
Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.
9
Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
10
Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain.
11
Health Technology Assessment Unit, Lain Entralgo Agency, Madrid, Spain.
12
QuintilesIMS, Madrid, Spain.
13
Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain.

Abstract

BACKGROUND:

Few economic evaluations have assessed laparoscopy for colon cancer. This study aimed to compare the cost-effectiveness of laparoscopic and open surgery for the treatment of colon cancer.

METHOD:

A cost-effectiveness analysis was performed comparing two groups of patients treated according to standard clinical practice (REDISSEC-CARESS/CCR cohort) by laparoscopic or open surgery. Data were collected from health records on clinical characteristics and resource use over 2 years after surgery. To calculate the incremental cost-effectiveness ratio, costs and quality-adjusted life years (QALYs) were obtained for each patient. Clinical heterogeneity was addressed using propensity score and joint multivariable analysis (seemingly unrelated regression) that included interactions between TNM stage, age, and surgical procedure to perform subgroup analysis.

RESULTS:

The sample was composed of 1591 patients, 963 who underwent laparoscopy and 628 open surgery. Using propensity score and regression analysis, we found that laparoscopy was associated with more QALYs and less resource use than open surgery (0.0163 QALYs, 95% CI 0.0114-0.0212; and - €3461, 95% CI - 3337 to - 3586). Costs were lower for laparoscopy in all subgroups. In the subgroups younger than 80 years old, utility was higher in patients who underwent laparoscopy. Nevertheless, open surgery had better outcomes in older patients in stages I-II (0.0618 QALYs) and IV (0.5090 QALYs).

CONCLUSION:

Overall, laparoscopy appears to be dominant, resulting in more QALYs and lower costs. Nevertheless, while laparoscopy required fewer resources in all subgroups, outcomes may be negatively affected in elderly patients, representing an opportunity for shared decision making between surgeons and patients. ClinicalTrials.gov Identifier: NCT02488161.

KEYWORDS:

Colon cancer; Cost-effectiveness; Laparoscopy; Open surgery

PMID:
29869084
DOI:
10.1007/s00464-018-6250-9

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