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Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer.

Abstract

BACKGROUND

Laparoscopic surgery for colorectal cancer has been shown in clinical trials to be effective regarding short-term outcomes and oncologically safe. Health economic analyses have been performed early in the learning curve when adoption of laparoscopic surgery was not extensive. This cost-effectiveness analysis evaluates laparoscopic versus open colorectal cancer surgery in Swedish routine care.

METHODS

In this national retrospective cohort study, data were retrieved from the Swedish ColoRectal Cancer Registry. Clinical effectiveness, resource use and unit costs were derived from this and other sources with nationwide coverage. The study period was 2013 and 2014 with 1 year follow-up. Exclusion criterion comprised cT4-tumors. Clinical effectiveness was estimated in a composite endpoint of all-cause resource-consuming events in inpatient care, readmissions and deaths up to 90 days postoperatively. Up to 1 year, events predefined as related to the primary surgery were included. Costs included resource-consuming events, readmissions and sick leave and were estimated for both the society and healthcare. Multivariable regression analyses were used to adjust for differences in baseline characteristics between the groups.

RESULTS

After exclusion of cT4 tumors, the cohort included 7707 patients who underwent colorectal cancer surgery: 6060 patients in the open surgery group and 1647 patients in the laparoscopic group. The mean adjusted difference in clinical effectiveness between laparoscopic and open colorectal cancer surgery was 0.23 events (95% CI 0.12 to 0.33). Mean adjusted differences in costs (open minus laparoscopic surgery) were $4504 (95% CI 2257 to 6799) and $4480 (95% CI 2739 to 6203) for the societal and the healthcare perspective respectively. In both categories, resource consuming events in inpatient care were the main driver of the results.

CONCLUSION

In a national cohort, laparoscopic colorectal cancer surgery was associated with both superior outcomes for clinical effectiveness and cost versus open surgery.

Authors+Show Affiliations

Department of Surgery, Institute of Clinical Sciences, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, 416 50, Gothenburg, Sweden. jacob.gehrman@gu.se. PharmaLex (Formerly Nordic Health Economics), Medicinaregatan 8, 413 90, Gothenburg, Sweden. jacob.gehrman@gu.se.Department of Surgery, Institute of Clinical Sciences, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, 416 50, Gothenburg, Sweden.Department of Surgery, Institute of Clinical Sciences, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, 416 50, Gothenburg, Sweden. PharmaLex (Formerly Nordic Health Economics), Medicinaregatan 8, 413 90, Gothenburg, Sweden.PharmaLex (Formerly Nordic Health Economics), Medicinaregatan 8, 413 90, Gothenburg, Sweden.Department of Surgery, Institute of Clinical Sciences, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, 416 50, Gothenburg, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630289

Citation

Gehrman, Jacob, et al. "Cost-effectiveness Analysis of Laparoscopic and Open Surgery in Routine Swedish Care for Colorectal Cancer." Surgical Endoscopy, 2019.
Gehrman J, Angenete E, Björholt I, et al. Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer. Surg Endosc. 2019.
Gehrman, J., Angenete, E., Björholt, I., Lesén, E., & Haglind, E. (2019). Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer. Surgical Endoscopy, doi:10.1007/s00464-019-07214-x.
Gehrman J, et al. Cost-effectiveness Analysis of Laparoscopic and Open Surgery in Routine Swedish Care for Colorectal Cancer. Surg Endosc. 2019 Oct 17; PubMed PMID: 31630289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer. AU - Gehrman,Jacob, AU - Angenete,Eva, AU - Björholt,Ingela, AU - Lesén,Eva, AU - Haglind,Eva, Y1 - 2019/10/17/ PY - 2019/03/25/received PY - 2019/10/09/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - Colorectal cancer KW - Cost-effectiveness analysis KW - Laparoscopic surgery JF - Surgical endoscopy JO - Surg Endosc N2 - BACKGROUND: Laparoscopic surgery for colorectal cancer has been shown in clinical trials to be effective regarding short-term outcomes and oncologically safe. Health economic analyses have been performed early in the learning curve when adoption of laparoscopic surgery was not extensive. This cost-effectiveness analysis evaluates laparoscopic versus open colorectal cancer surgery in Swedish routine care. METHODS: In this national retrospective cohort study, data were retrieved from the Swedish ColoRectal Cancer Registry. Clinical effectiveness, resource use and unit costs were derived from this and other sources with nationwide coverage. The study period was 2013 and 2014 with 1 year follow-up. Exclusion criterion comprised cT4-tumors. Clinical effectiveness was estimated in a composite endpoint of all-cause resource-consuming events in inpatient care, readmissions and deaths up to 90 days postoperatively. Up to 1 year, events predefined as related to the primary surgery were included. Costs included resource-consuming events, readmissions and sick leave and were estimated for both the society and healthcare. Multivariable regression analyses were used to adjust for differences in baseline characteristics between the groups. RESULTS: After exclusion of cT4 tumors, the cohort included 7707 patients who underwent colorectal cancer surgery: 6060 patients in the open surgery group and 1647 patients in the laparoscopic group. The mean adjusted difference in clinical effectiveness between laparoscopic and open colorectal cancer surgery was 0.23 events (95% CI 0.12 to 0.33). Mean adjusted differences in costs (open minus laparoscopic surgery) were $4504 (95% CI 2257 to 6799) and $4480 (95% CI 2739 to 6203) for the societal and the healthcare perspective respectively. In both categories, resource consuming events in inpatient care were the main driver of the results. CONCLUSION: In a national cohort, laparoscopic colorectal cancer surgery was associated with both superior outcomes for clinical effectiveness and cost versus open surgery. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/31630289/Cost-effectiveness_analysis_of_laparoscopic_and_open_surgery_in_routine_Swedish_care_for_colorectal_cancer L2 - https://dx.doi.org/10.1007/s00464-019-07214-x DB - PRIME DP - Unbound Medicine ER -