The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Abstract

The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.