Gehrman Jacob, Björholt Ingela, Angenete Eva, Andersson John, Bonjer Jaap, Haglind Eva
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden.
Nordic Health Economics, Gothenburg, Sweden.
Surg Endosc. 2017 Mar;31(3):1225-1234. doi: 10.1007/s00464-016-5096-2. Epub 2016 Jul 15.
Previous studies regarding the comparative costs of laparoscopic and open surgery for rectal cancer provide ambiguous conclusions, and there are no large randomized trials or long-term follow-up.
A prospective cost-minimization analysis was carried out by using data of clinical resource use from the randomized controlled trial COLOR II. Some data needed for the health economic evaluation were not collected in the clinical trial; therefore, a retrospective data collection was made for COLOR II-patients operated at the largest participating Swedish hospital (n = 105). Sick leave information was provided by the Swedish social insurance agency. Unit costs were collected from Swedish sources. The primary outcome was the difference in mean cost between laparoscopic and open surgery.
The COLOR II-trial enrolled 1044 rectal cancer patients randomized between laparoscopic and open surgery 2:1. At the 3-year follow-up data for the clinical variables used in the analysis were available for 74-89 % of patients. Laparoscopic surgery costs the health care sector more than the open technique, both at 28 days ($1910, 95 % CI 677-3143) and 3 years ($3854, 95 % CI 1527-6182) after surgery. There were, however, no differences in long-term costs to society between laparoscopic and open surgery ($684, 95 % CI -5799 to 7166).
Though the study found short- and long-term cost differences for the healthcare sector, there was no difference in regard to the long-term societal perspective. Future research is suggested to investigate the effects of sick leave costs using material from a greater number of patients.
以往关于直肠癌腹腔镜手术与开放手术比较成本的研究得出的结论不明确，且尚无大型随机试验或长期随访。
利用随机对照试验COLOR II的临床资源使用数据进行前瞻性成本最小化分析。健康经济评估所需的一些数据在临床试验中未收集；因此，对在瑞典最大的参与医院接受手术的COLOR II患者（n = 105）进行了回顾性数据收集。病假信息由瑞典社会保险机构提供。单位成本从瑞典来源收集。主要结局是腹腔镜手术与开放手术之间的平均成本差异。
COLOR II试验纳入了1044例直肠癌患者，以2:1的比例随机分配接受腹腔镜手术和开放手术。在3年随访时，分析中使用的临床变量的74 - 89%的患者有可用数据。腹腔镜手术在术后28天（1910美元，95%可信区间677 - 3143）和3年（3854美元，95%可信区间1527 - 6182）的医疗保健部门成本均高于开放技术。然而，腹腔镜手术和开放手术在对社会的长期成本方面没有差异（684美元，95%可信区间 - 5799至7166）。
尽管该研究发现了医疗保健部门在短期和长期的成本差异，但从长期社会角度来看没有差异。建议未来的研究使用更多患者的资料来调查病假成本的影响。
