تحلیل همتایابی نمره تمایل و هزینه تک برش در مقابل جراحی معمول برای سرطان
Summary
1- Introduction
2- Methods
3- Results
4- Discussion
References
Summary
Background/objective: Although many studies have demonstrated similar perioperative outcomes for single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for colon cancer, few have directly compared the costs of them. We aimed to compare costs between SILS and CLS for colon cancer.
Methods: We analyzed the clinical outcomes and overall hospital costs of patients who underwent laparoscopic surgery for colon cancer from July 2009 to September 2014 at our institution; 288 were used for analysis after propensity score matching. The total hospital charge, including fees for the operation, anesthesia, preoperative diagnosis, and postoperative management was analyzed.
Results: The total hospital charges were similar in both groups ($8770.40 vs. $8352.80, P Z 0.099). However, the patients’ total hospital bill was higher in the SILS group than in the CLS group ($4184.82 vs. $3735.00, P < 0.001) mainly due to the difference of the cost of access devices. There was no difference in the additional costs associated with readmission due to late complications between the two groups ($2383.08 vs. $2288.33, P Z 0.662). Incremental cost-effectiveness ratio for total incision length in ‘total hospital charge’ and patient’s bill and government’s bill in ‘cost of instruments and supplies’ were -$107.08/1 cm, -$109.70/ 1 cm, and $80.64/1 cm, respectively.
Introduction
Minimally invasive surgery (MIS), including laparoscopic surgery (LS) and robotic surgery, has shown to have acceptable short- and long-term outcomes in the context of various diseases.1e3 LS is an option for colorectal cancer based on the similar or even superior results associated with the procedure compared with those of open surgery for colorectal malignancies.4e6 Novel techniques, such as natural orifice transluminal endoscopic surgery or singleincision laparoscopic surgery (SILS), have been developed to meet surgeons’ efforts to maximize the advantages of MIS and the patients’ desires to reduce scarring and pain. SILS, which is characterized by only one surgical incision, has been suggested as an option for treating colorectal malignancies. SILS for colon cancer has shown comparable oncologic outcomes, as well as a shorter total incision length, when compared with conventional laparoscopic surgery (CLS).7e10 However, it has several limitations as an alternative treatment option for colorectal cancer, including patient selections, technical difficulties, and questionable cost-effectiveness.11,12 Therefore, recent studies of SILS for colorectal cancer have attempted to clarify the learning curve for both LSexperienced surgeons and novices, to expand the indications for SILS, and more comfortable technical tips, whereas prior studies have primarily focused on the safety and feasibility of the procedure.13,14 However, to date there has been no cost-effectiveness study of SILS for colon cancer, and only a few studies having reported the costs associated with the procedure. The aim of the current study was to focus on the comparative costs of SILS versus CLS for colon cancer. We compared the costs of SILS with those of CLS, subdividing the total hospital charges into five categories.