Liem M S, Halsema J A, van der Graaf Y, Schrijvers A J, van Vroonhoven T J
Department of General Surgery, University Hospital, Utrecht, The Netherlands.
Ann Surg. 1997 Dec;226(6):668-75; discussion 675-6. doi: 10.1097/00000658-199712000-00004.
To determine the cost-effectiveness of laparoscopic inguinal hernia repair.
Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed.
After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire.
Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair.
A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective.
确定腹腔镜腹股沟疝修补术的成本效益。
就短期效果而言，腹腔镜腹股沟疝修补术似乎优于开放手术。该手术的成本效益仍是一个有待深入研究的问题。作为一项纳入了1000多名患者的多中心随机研究的一部分，我们从社会角度进行了成本效益分析。
在获得知情同意后，前瞻性记录了1994年8月至1995年7月期间患者在医院内外的所有资源成本。实际成本根据国际指南以标准化方式计算。评估腹股沟疝修补术的主要指标是避免复发的次数和用简短健康调查问卷（Short Form 36 questionnaire）测量的生活质量。
记录了273例患者的资源成本，其中开放手术组139例，腹腔镜组134例。两组在基线时具有可比性。开放修补组的平均总住院费用为1384.91荷兰盾（标准差：440.15荷兰盾），腹腔镜修补组为2417.24荷兰盾（标准差：577.10荷兰盾），其中包括一次性器械包费用676荷兰盾。腹腔镜修补术的社会成本，包括病假天数的成本较低，抵消了780.83荷兰盾（75.6%）的住院费用，使腹腔镜修补术仅贵251.50荷兰盾（4665荷兰盾对4916.50荷兰盾）。目前，腹腔镜修补术后的复发率低2.6%。因此，38例腹腔镜修补术虽额外花费9557荷兰盾，但可预防一例复发性疝的发生。腹腔镜修补术后生活质量更好。
恢复期更好的生活质量以及用可重复使用器械替代部分一次性器械包的可能性，可能使腹腔镜修补术从社会角度看具有显著优势——即成本更低且更有效。
