In this cost-effectiveness analysis together with a randomized clinical trial of 227 patients with gastric cancer, although laparoscopic gastrectomy itself was more expensive, after 1 year of follow-up, the differences in both total costs and effectiveness were limited between laparoscopic and open gastrectomy. .
The findings suggest that comparable costs and cost-effectiveness support centers choosing, based on their own preferences, whether to (de)implement laparoscopic gastrectomy as an alternative to open gastrectomy.
Laparoscopic gastrectomy is rapidly being adopted worldwide as an alternative to open gastrectomy to treat gastric cancer. However, laparoscopic gastrectomy can be more expensive as a result of longer operating times and more expensive surgical materials.
To date, the cost-effectiveness of both procedures has not been prospectively evaluated in a randomized clinical trial.
In this multicenter randomized clinical trial of patients undergoing total or distal gastrectomy at 10 Dutch tertiary referral centers, cost-effectiveness data were collected together with a multicenter randomized clinical trial of laparoscopic versus open gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0- 3bM0).
A modified social perspective and a 1-year time horizon were used. Costs were calculated at the individual patient level using data from hospital records and medical consumption and productivity loss questionnaires.
The unit costs of laparoscopic and open gastrectomy were calculated from the bottom up. Quality-adjusted life years (QALYs) were calculated with the 5-dimensional EuroQol questionnaire, in which a value of 0 indicates death and 1 indicates perfect health. Missing data from the questionnaire were imputed with multiple imputation. Bootstrapping was performed to estimate the uncertainty surrounding profitability.
The study was conducted from March 17, 2015 to August 20, 2018. Data analyzes were conducted between September 1, 2020 and November 17, 2021.
Editor’s note : Bootstrapping (or bootstrap) is a resampling method proposed by Bradley Efron in 1979. It is used to approximate the sampling distribution of a statistic. It is frequently used to approximate the bias or variance of a statistical analysis, as well as to construct confidence intervals or perform hypothesis tests on parameters of interest. In most cases closed expressions cannot be obtained for bootstrap approximations and it is therefore necessary to obtain resamples on a computer to test the method. The enormous computing power of current computers considerably facilitates the applicability of this very expensive method. computationally. (Source Wikipedia)
Between 2015 and 2018 , 227 patients were included . The mean (SD) age was 67.5 (11.7) years, and 140 were men (61.7%).
Unit costs for the initial surgery were calculated as €8,124 (US $8,087) for laparoscopic total gastrectomy, €7,353 (US $7,320) for laparoscopic distal gastrectomy, €6,584 (US $6,554) for open total gastrectomy, and €5,893 (US $5,866) for Open distal gastrectomy.
The mean total costs after one year of follow-up were €26,084 (US$25,965) in the laparoscopic group and €25,332 (US$25,216) in the open group (difference, €752 [US$749; 3.0%]).
The mean (SD) QALY contributions over 1 year were 0.665 (0.298) in the laparoscopic group and 0.686 (0.288) in the open group (difference, −0.021). These differences between treatment groups were relatively small compared to the uncertainty of the analysis.
Although laparoscopic gastrectomy itself was more expensive , after one year of follow-up, the results suggest that differences in both total costs and effectiveness were limited between laparoscopic and open gastrectomy.
Bootstrapping showed that these results support centers choosing, based on their own preferences, whether to (de)implement laparoscopic gastrectomy as an alternative to open gastrectomy .
