Laparoscopic, open gastrectomy yield similar cost-effectiveness for gastric cancer
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Cost-effectiveness analysis revealed limited differences between laparoscopic vs. open gastrectomy at 1-year follow-up among a cohort of Dutch patients with gastric cancer, according to results published in JAMA Surgery.
“Open gastrectomy has long been the criterion standard worldwide. However, application of laparoscopic gastrectomy for advanced gastric cancer is estimated to have increased,” Arjen van der Veen, MD, PhD, of the department of surgery at University Medical Center Utrecht, and colleagues wrote. “Costs of the laparoscopic operation itself (the unit costs) are expected to be higher compared with open gastrectomy owing to longer operating times and surgical materials or disposables.
“The clinical benefit of laparoscopic gastrectomy has not been proven so far, whereas its unit costs might be higher, which necessitates a dedicated randomized cost-effectiveness analysis between both procedures.”
Using data from the Laparoscopic vs. Open Gastrectomy for Gastric Cancer trial, van der Veen and colleagues conducted an economic evaluation of the cost and quality-adjusted life-years (QALYs) among 227 patients (61.7% men; mean age, 67.5 years) who underwent total or distal gastrectomy between 2015 and 2018.
Researchers calculated cost on individual patient levels using hospital registry data and medical consumption and productivity loss questionnaires. The EuroQol 5-dimension (EQ-5D) questionnaire aided determination of QALYs, in which a value of 0 indicated death and 1 indicated perfect health. Bootstrapping was used to estimate uncertainty surrounding cost-effectiveness.
According to analysis, the unit costs for initial surgery were $8,087 for laparoscopic total gastrectomy, $7,320 for laparoscopic distal gastrectomy, $6,554 for open total gastrectomy and $5,866 for open distal gastrectomy. Mean initial surgery costs were $7,346 among patients who underwent laparoscopic surgery and $5,945 among patients who underwent open gastrectomy, while mean re-operation costs were $316 and $307, respectively. After 1-year follow-up, the mean total costs were $25,965 and $25,216, accounting for a difference of 3%.
After adjusting for baseline QALYs and stratification factors, researchers noted decreased EQ-5D values 1 year postoperatively for both the laparoscopic (0.819-0.665) and open (0.829-0.288) surgery groups. Bootstrapping analysis showed minimal differences between treatment groups compared with the uncertainty of analysis.
“The comparable cost-effectiveness between treatment groups in the current study supports centers’ choosing, based on their own preference, whether to (de)implement laparoscopic gastrectomy as an alternative to open gastrectomy,” van der Veen and colleagues concluded. “Although laparoscopic gastrectomy unit costs were higher, differences in both total costs and cost-effectiveness up to 1 year postoperatively were limited between laparoscopic and open gastrectomy.”
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