Medical Student - School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK.
Int J Colorectal Dis. 2012 Jul;27(7):855-60. doi: 10.1007/s00384-012-1410-1. Epub 2012 Jan 31.
Several studies have confirmed that laparoscopic colorectal surgery (LCS) has superior short-term outcomes when compared to open colorectal surgery. However, the evidence for cost-effectiveness of LCS is less clear.
The aim of this study is to explore the cost-effectiveness of LCS over time since it was first developed in 1991.
Systematic review of the literature was conducted. Electronic databases (PubMed, ScienceDirect and Google Scholar) were searched for studies from 1991 to 2010 using the keywords "laparoscopic, colorectal surgery cost, economic evaluation".
Fifteen economic evaluations met the inclusion criteria. The percentage cost difference between open and laparoscopic surgery varied widely between different studies. The general trend when observing all the included economic evaluations is that there is a moderate negative correlation between progression of time and the size of the cost gap between laparoscopic and open surgery (R-value=-0.44). This correlation is even stronger (R-value=-0.64, P=0.046) if the studies are subdivided by the country where the surgery was carried out in. Western healthcare systems, even though they had a heterogeneous set of results (SD=27%), showed a decline in costs of laparoscopic surgery with time.
From the current trends, it is projected that the results of future economic evaluations will unequivocally show that laparoscopic surgery is cheaper than open surgery. The initial higher costs of laparoscopic surgery training may be worth the savings made in the long term if it is practised in settings where postoperative care is expensive.
多项研究证实，腹腔镜结直肠手术（LCS）在短期疗效方面优于开腹结直肠手术。然而，关于 LCS 的成本效益的证据尚不清楚。
本研究旨在探讨自 1991 年首次开展 LCS 以来，其成本效益随时间的变化情况。
对文献进行系统评价。使用“腹腔镜、结直肠手术成本、经济评估”等关键词，在电子数据库（PubMed、ScienceDirect 和 Google Scholar）中检索 1991 年至 2010 年的研究。
符合纳入标准的经济评价有 15 项。开放手术和腹腔镜手术之间的成本差异百分比在不同研究中差异很大。观察所有纳入的经济评价的总体趋势是，随着时间的推移，腹腔镜手术和开放手术之间的成本差距呈中度负相关（R 值=-0.44）。如果按手术所在国家对研究进行细分，这种相关性更强（R 值=-0.64，P=0.046）。即使结果存在异质性（标准差=27%），西方医疗体系的腹腔镜手术成本也随着时间的推移呈下降趋势。
从目前的趋势来看，可以预计未来的经济评价结果将明确表明腹腔镜手术比开放手术更便宜。如果在术后护理费用较高的环境中开展腹腔镜手术，那么初期腹腔镜手术培训的较高成本从长远来看可能是值得的。
