Abstract
BackgroundPrevious 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.MethodsA 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.ResultsThe 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).ConclusionsThough 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.
Highlights
Background 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
Some data needed for the health economic evaluation were not collected in the clinical trial; a retrospective data collection was made for COLOR II-patients operated at the largest participating Swedish hospital (n = 105)
In the short time perspective, it made little difference ($1828, 95 % CI 513–3144) (SEK, 11909). This health economic evaluation of laparoscopic and open surgery for rectal cancer in the framework of the randomized trial COLOR II showed that laparoscopy was significantly more costly from the societal perspective at 28 days, but no statistical significance was detected at 3 years
Summary
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. The short-term outcomes of the ACOSOG Z6051 [4] and ALaCaRT [5] randomized clinical trials of laparoscopic and open rectal cancer resections failed to establish non-inferiority in terms of the pathological and adequate surgical resection outcomes. These trials have, used other endpoints, both are short-term and the group sizes are such that
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