Krog Anne Helene, Sahba Mehdi, Pettersen Erik M, Wisløff Torbjørn, Sundhagen Jon O, Kazmi Syed Sh
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo.
Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
Vasc Health Risk Manag. 2017 Jun 19;13:217-224. doi: 10.2147/VHRM.S138516. eCollection 2017.
Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients' health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass.
This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay.
We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (=0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), (=0.001).
Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.
在专业中心，腹腔镜腹主动脉双股动脉搭桥术已成为有症状的主-髂动脉闭塞性疾病的既定治疗选择。像腹腔镜手术这样的微创手术技术常常已被证明可降低费用并提高患者与健康相关的生活质量。我们研究的主要目的是测量全腹腔镜和开放腹主动脉双股动脉搭桥术后的质量调整生命年（QALYs）和成本。
这是一项正在进行的更大规模随机对照前瞻性多中心试验（挪威腹腔镜主动脉手术试验）中的试验内分析。连续50例患有适合腹主动脉双股动脉搭桥手术的有症状主-髂动脉闭塞性疾病的患者被随机分为全腹腔镜手术组（n = 25）或开放手术组（n = 25）。1例患者在手术前退出研究。我们在4个不同时间点，即手术前和随访期间的6个月，使用欧洲五维健康量表（EQ - 5D - 5L）问卷测量与健康相关的生活质量。我们通过计算两组曲线下面积来获得QALYs。成本是根据手术设备、血管假体和住院时间的价格计算的。
我们发现腹腔镜腹主动脉双股动脉搭桥术后QALYs的增加显著高于开放手术，差异为0.07 QALYs，（P = 0.001），有利于腹腔镜腹主动脉双股动脉搭桥术。腹腔镜手术后手术、设备和住院的总成本（9953欧元）低于开放手术（17260欧元），（P = 0.001）。
与开放手术相比，腹腔镜腹主动脉双股动脉搭桥术似乎具有成本效益，因为QALYs增加且与手术相关的成本较低。
