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Cost-Effectiveness of Laparoscopic vs Open Resection for Colon and Rectal Cancer

Jensen, Christine C. M.D., M.P.H.1; Prasad, Leela M. M.D.2; Abcarian, Herand M.D.2

doi: 10.1097/DCR.0b013e3182656898
Original Contributions: Colorectal/Anal Neoplasia

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.

1Colon and Rectal Surgery Associates, Department of Surgery, University of Minnesota, St. Paul, Minnesota

2Department of Surgery, University of Illinois at Chicago, Chicago, Illinois

Financial Disclosure: None reported.

Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Vancouver, BC, Canada, May 14 to 18, 2011.

Correspondence: Christine C. Jensen, M.D., M.P.H., 1055 Westgate Dr, Suite 190, St. Paul, MN 55114. E-mail: cjensen@crsal.org

© The ASCRS 2012