Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom.
Leeds Institute of Medical Research at St. James', University of Leeds, Leeds, United Kingdom.
PLoS One. 2022 Aug 3;17(8):e0271559. doi: 10.1371/journal.pone.0271559. eCollection 2022.
Laparoscopic surgery, a minimally invasive technique to treat abdominal conditions, has been shown to produce equivalent safety and efficacy with quicker return to normal function compared to open surgery. As such, it is widely accepted as a cost-effective alternative to open surgery for many abdominal conditions. However, access to laparoscopic surgery in rural North-East India is limited, in part due to limited equipment, unreliable supplies of CO2 gas, lack of surgical expertise and a shortage of anaesthetists. We evaluate the cost-effectiveness of gasless laparoscopy as a means to increase provision of minimally invasive surgery (MIS) for abdominal conditions in rural North-East India. A decision tree model was developed to compare costs, evaluated from a patient perspective, and health outcomes, disability adjusted life years (DALYs), associated with gasless laparoscopy, conventional laparoscopy or open abdominal surgery in rural North-East India. Results indicate that MIS (performed by conventional or gasless laparoscopy) is less costly and produces better outcomes, fewer DALYs, than open surgery. These results were consistent even when gasless laparoscopy was analysed using least favourable data from the literature. Scaling up provision of MIS through increased access to gasless laparoscopy would reduce the cost burden to patients and increase DALYs averted. Based on a sample of 12 facilities in the North-East region, if scale up was achieved so that all essential surgeries amenable to laparoscopic surgery were performed as such (using conventional or gasless laparoscopy), 64% of DALYS related to these surgeries could be averted, equating to an additional 454.8 DALYs averted in these facilities alone. The results indicate that gasless laparoscopy is likely to be a cost-effective alternative to open surgery for abdominal conditions in rural North-East India and provides a possible bridge to the adoption of full laparoscopic services.
腹腔镜手术是一种治疗腹部疾病的微创技术，与开放手术相比，它具有同等的安全性和疗效，并且能更快地恢复正常功能。因此，它被广泛认为是许多腹部疾病的一种具有成本效益的替代开放手术的方法。然而，在印度东北部农村，腹腔镜手术的可及性有限，部分原因是设备有限、二氧化碳气体供应不可靠、缺乏手术专业知识以及麻醉师短缺。我们评估了无气腹腔镜作为增加印度东北部农村微创腹部手术（MIS）提供的一种手段的成本效益。从患者角度评估，建立了一个决策树模型来比较无气腹腔镜、传统腹腔镜或开放腹部手术的成本和健康结果，即残疾调整生命年（DALYs）。结果表明，MIS（通过传统腹腔镜或无气腹腔镜进行）的成本更低，且效果更好，DALYs 更少，比开放手术好。即使使用文献中最不利的数据对无气腹腔镜进行分析，结果仍然如此。通过增加无气腹腔镜的使用来扩大 MIS 的提供，可以减轻患者的经济负担并增加避免的 DALYs。根据东北地区 12 个设施的样本，如果实现了规模扩大，使所有适合腹腔镜手术的基本手术都采用这种手术（使用传统腹腔镜或无气腹腔镜），则可以避免 64%与这些手术相关的 DALYs，仅在这些设施中就可以避免额外的 454.8 个 DALYs。结果表明，无气腹腔镜可能是印度东北部农村地区腹部疾病的一种具有成本效益的替代开放手术的方法，并为采用全腹腔镜服务提供了一种可能的途径。
