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Surgical Endoscopy

, Volume 24, Issue 5, pp 1075–1079 | Cite as

Opportunity cost in the evaluation of surgical innovations: a case study of laparoscopic versus open colectomy

  • Abhishek Chatterjee
  • Lilian Chen
  • Elie A. Goldenberg
  • Harold T. Bae
  • Samuel R. G. Finlayson
Article

Abstract

Background

Opportunity cost is the value of an activity forgone for participation in some other activity. With respect to surgery, an innovation incurs an opportunity cost when it uses additional operating time that could otherwise be used in a productive way. This report describes an example of assessing opportunity cost in the transition from open to laparoscopic colectomy using pooled analysis data from the surgical literature and hospital financial data.

Methods

A MEDLINE literature search was performed between the years 1998 and 2008. Data were pooled from the identified studies used for the statistical analysis of cost and operating room time differences between laparoscopic versus open colectomy. The analysis identified five commonly performed, elective general surgery procedures. The profit margins of these procedures then were determined and divided by their average surgical time to calculate a range of opportunity cost multipliers. Finally, these opportunity cost multipliers were applied to the additional time required for performance of laparoscopic colectomy to demonstrate that procedure’s true overall cost.

Results

Seven comparative studies were identified. The pooled analysis showed that the operating time was longer for a laparoscopic colectomy by 27.08 min (p < 0.0001). Additionally, laparoscopic colectomies had slightly higher total costs ($104.67 difference), but this difference was not statistically significant (p = 0.28). The five commonly performed, elective procedures chosen were laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, breast biopsy, partial mastectomy, and total thyroidectomy, and their opportunity cost multipliers ranged from $9 to $26 per minute. Depending on the opportunity cost multiplier used, the opportunity cost of an additional 27.08 min required to perform laparoscopic colectomy ranges from $243.72 to $704.08, which is approximately two to six times greater than the point estimate of the difference in total costs based on published studies.

Conclusions

Although frequently overlooked, opportunity cost is a potentially very important element in assessing the true costs of surgical innovation.

Keywords

Additional operating time Laparoscopic colectomy Open colectomy Opportunity cost Surgical innovation 

Notes

Disclosures

Abhishek Chatterjee, Lilian Chen, Elie A. Goldenberg, Harold T. Bae, and Samuel R. G. Finlayson and have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Gafni A, Birch S (1993) Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem. CMAJ 148:913–917PubMedGoogle Scholar
  2. 2.
    Ginsburg PB (2004) Controlling health care costs. N Engl J Med 351:1591–1593CrossRefPubMedGoogle Scholar
  3. 3.
    Laupacis A, Feeny D, Detsky AS, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 146:473–481PubMedGoogle Scholar
  4. 4.
    Young-Fadok TM, Hall-Long K, McConnell EJ, Gomez Rey G, Cabanela RL (2001) Advantages of laparoscopic resection for ileocolic Crohn’s disease: improved outcomes and reduced costs. Surg Endosc 15:450–454CrossRefPubMedGoogle Scholar
  5. 5.
    Shore G, Gonzalez QH, Bondora A, Vickers SM (2003) Laparoscopic vs conventional ileocolectomy for primary Crohn disease. Arch Surg 138:76–79CrossRefPubMedGoogle Scholar
  6. 6.
    Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824CrossRefPubMedGoogle Scholar
  7. 7.
    Joo JS, Amarnath L, Wexner SD (1998) Is laparoscopic resection of colorectal polyps beneficial? Surg Endosc 12:1341–1344CrossRefPubMedGoogle Scholar
  8. 8.
    Salloum RM, Bulter DC, Schwartz SI (2006) Economic evaluation of minimally invasive colectomy. J Am Coll Surg 202:269–274CrossRefPubMedGoogle Scholar
  9. 9.
    Koopmann MC, Harms BA, Heise CP (2007) Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies. Surgery 142:546–553 (discussion 53–55)CrossRefPubMedGoogle Scholar
  10. 10.
    Khalili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian C, Tsushima G et al (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41:832–838CrossRefPubMedGoogle Scholar
  11. 11.
    Russell LB (1992) Opportunity costs in modern medicine. Health Aff (Millwood) 11:162–169CrossRefGoogle Scholar
  12. 12.
    Palmer S, Raftery J (1999) Economic notes: opportunity cost. BMJ 318:1551–1552PubMedGoogle Scholar
  13. 13.
    Hedges LV, Olikin I (1985) Statistical methods for meta-analysis. Academic Press, Orlando, FLGoogle Scholar
  14. 14.
    Higgins JPT, Green S (2008) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Retrieved at www.cochrane-handbook.org. Accessed 20 May 2009
  15. 15.
    Matin SF (2003) Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. J Am Coll Surg 196:845–853CrossRefPubMedGoogle Scholar
  16. 16.
    Bacchetta MD, Girardi LN, Southard EJ, Mack CA, Ko W, Tortolani AJ et al (2005) Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patient: outcomes and financial analysis. Ann Thorac Surg 79:1879–1885CrossRefPubMedGoogle Scholar
  17. 17.
    Kohler L, Rixen D, Troidl H (1998) Laparoscopic colorectal resection for diverticulitis. Int J Colorectal Dis 13:43–47CrossRefPubMedGoogle Scholar
  18. 18.
    Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45:605–610CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Abhishek Chatterjee
    • 1
    • 5
  • Lilian Chen
    • 2
  • Elie A. Goldenberg
    • 3
  • Harold T. Bae
    • 4
  • Samuel R. G. Finlayson
    • 1
  1. 1.Department of SurgeryDartmouth Hitchcock Medical CenterLebanonUSA
  2. 2.Dartmouth Medical SchoolLebanonUSA
  3. 3.Department of SurgeryDartmouth Clinic at Concord HospitalLebanonUSA
  4. 4.Dartmouth Institute of Health Policy and Clinical PracticeLebanonUSA
  5. 5.White River JunctionUSA

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