Cost-effectiveness of laparoscopic vs open resection for colon and rectal cancer.

BACKGROUND

Whether laparoscopic surgery for colon and rectal cancer is cost-effective in comparison with open surgery remains unclear, because laparoscopic surgery results in shorter hospital stays but is associated with increased equipment costs.

OBJECTIVE

This study aimed to investigate the cost-effectiveness of laparoscopic versus open surgery for colon and rectal cancer, incorporating factors not included in previous cost-effectiveness studies.

DESIGN

A decision analysis model was constructed, and extensive sensitivity analyses were performed to test the assumptions of the model.

SETTING

Data were taken from previously published studies; data from large randomized trials were used whenever possible as inputs into the model.

PATIENTS

Patients enrolled in the trials from which data were gathered for the model.

INTERVENTIONS

There were no interventions.

MAIN OUTCOME MEASURES

The primary outcome measured was the cost-effectiveness of laparoscopic versus open surgery for colon and rectal cancer, expressed as cost per quality-adjusted life-year.

RESULTS

Laparoscopic resection results in savings of $4283 and essentially no difference in quality-adjusted life-years (0.001 more quality-adjusted life-years than open resection). Sensitivity analyses indicate that laparoscopic surgery is cost-effective at <$50,000 per quality-adjusted life-year under almost all conditions. The only circumstance that affects the cost-effectiveness of laparoscopic surgery is postoperative hernia rates. Because of the additional time off work for hernia repair, laparoscopic resection is cost-effective only if it results in a hernia rate less than or equal to open surgery. For all other variables, the laparoscopic approach remains less costly than the open approach with no difference in quality of life.

LIMITATIONS

The model relies on data from other studies, rather than being an independent trial designed to specifically collect these data.

CONCLUSIONS

Laparoscopic resection for colon and rectal cancer results in decreased costs and equivalent quality of life, making it the preferred approach in suitable patients.