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Surgical Endoscopy

, Volume 26, Issue 5, pp 1444–1453 | Cite as

Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer

  • Patrizia BertoEmail author
  • Stefania Lopatriello
  • Andrea Aiello
  • Francesco Corcione
  • Giuseppe Spinoglio
  • Vincenzo Trapani
  • Gianluigi Melotti
Article

Abstract

Background

The comparative costs of laparoscopy and laparotomy in surgical resection of colorectal cancer, especially of the hospital provider, have not yet been assessed in the perspective of the Italian National Healthcare System. This paper aims to fill this gap by providing economic information on this research topic of growing relevance at a time of reduced healthcare budgets.

Methods

Three Italian reference centres retrospectively provided from their databases data on 90 cases of laparotomy (OP) or laparoscopy (LAP) interventions for right colon (RCol), left colon/sigma (LCol) and rectum (Rec). Costs were retrieved according to phases of the in-hospital procedure: pre-operative, operative and post-operative phase, including diagnostic work-up, hospital length of stay, duration of intervention, theatre occupation time, type of anaesthesia, medical devices and drugs used and staff time throughout the management process from hospital admission to discharge. The cost estimation was carried out using a microcosting, bottom-up technique, and statistical analysis was carried out using appropriate techniques.

Results

The average cost of colorectal surgery was €10,539/patient (median €10,396) with rectum procedures being statistically more costly than colon procedures (mean Rec €12,562/patient versus LCol €9,054 and RCol €10,002; median €11,704 versus €8,941 and €9,513, respectively; p < 0.0001). The average cost per patient did not differ between the two procedures for colon interventions, whereas a statistically significant difference was found for rectum procedures (LAP €11,617 versus OP €13,506; median €11,563 versus €12,568; p = 0.0442). The national diagnosis related groups (DRG) tariff is insufficient to remunerate the providers’ activity, irrespective of the type of disease (surgical site) and surgical technique adopted.

Conclusion

Colorectal cancer surgery is a costly procedure, and in-patient DRG tariffs are currently insufficient to cover the cost of its management for Italian hospital providers.

Keywords

Colorectal cancer Surgery Laparoscopy Laparotomy Economics Cost 

Notes

Acknowledgements

This work was sponsored by an unrestricted grant from Ethicon Endo-Surgery Italy.

Disclosures

Authors Berto, Lopatriello, Aiello, Corcione, Spinoglio, Trapani, and Melotti have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    IARC WHO Agency for Research on Cancer. GLOBOCAN 2008: Cancer Incidence and Mortality Worldwide 2010 [cited 2010 Sep 20]Google Scholar
  2. 2.
    AIOM. I Tumori del Colon-Retto 2009 Sep 11 [cited 2010 Sep 20]Google Scholar
  3. 3.
    Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM, Taura P, Grande L, Fuster J, Pacheco JL et al (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9(10):1101–1105PubMedCrossRefGoogle Scholar
  4. 4.
    Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187(1):46–54PubMedCrossRefGoogle Scholar
  5. 5.
    Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA (2000) Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 14(11):1062–1066PubMedCrossRefGoogle Scholar
  6. 6.
    Leung KL, Kwok SP, Lau WY, Meng WC, Chung CC, Lai PB, Kwong KH (2000) Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma. Surg Endosc 14(1):67–70PubMedCrossRefGoogle Scholar
  7. 7.
    Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44(3):315–321PubMedCrossRefGoogle Scholar
  8. 8.
    Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di CV (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236(6):759–766PubMedCrossRefGoogle Scholar
  9. 9.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229PubMedCrossRefGoogle Scholar
  10. 10.
    Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287(3):321–328PubMedCrossRefGoogle Scholar
  11. 11.
    Araujo SE, da Silva eSousa AH Jr, de Campos FG, Habr-Gama A, Dumarco RB, Caravatto PP, Nahas SC, da SJ, Kiss DR, Gama-Rodrigues JJ (2003) Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sao Paulo 58(3):133–140PubMedCrossRefGoogle Scholar
  12. 12.
    Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M (2003) Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc 17(4):636–640PubMedCrossRefGoogle Scholar
  13. 13.
    Wu FP, Sietses C, von Blomberg BM, van Leeuwen PA, Meijer S, Cuesta MA (2003) Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial. Dis Colon Rectum 46(2):147–155PubMedCrossRefGoogle Scholar
  14. 14.
    Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E, Anderberg B (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91(4):409–417PubMedCrossRefGoogle Scholar
  15. 15.
    Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14(6):329–334PubMedGoogle Scholar
  16. 16.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363(9416):1187–1192PubMedCrossRefGoogle Scholar
  17. 17.
    Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S, Beart RW Jr (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRefGoogle Scholar
  18. 18.
    Vignali A, Braga M, Zuliani W, Frasson M, Radaelli G, Di CV (2004) Laparoscopic colorectal surgery modifies risk factors for postoperative morbidity. Dis Colon Rectum 47(10):1686–1693PubMedCrossRefGoogle Scholar
  19. 19.
    Wu WX, Sun YM, Hua YB, Shen LZ (2004) Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study. World J Gastroenterol 10(8):1167–1170PubMedGoogle Scholar
  20. 20.
    Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18(8):1211–1215PubMedCrossRefGoogle Scholar
  21. 21.
    Braga M, Vignali A, Zuliani W, Frasson M, Di SC, Di CV (2005) Laparoscopic versus open colorectal surgery: cost-benefit analysis in a single-center randomized trial. Ann Surg 242(6):890–895 discussionPubMedCrossRefGoogle Scholar
  22. 22.
    Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di CV (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48(12):2217–2223PubMedCrossRefGoogle Scholar
  23. 23.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726PubMedCrossRefGoogle Scholar
  24. 24.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484PubMedCrossRefGoogle Scholar
  25. 25.
    Arteaga GI, Diaz LH, Martin MA, Lopez-Tomassetti Fernandez EM, Arranz DJ, Carrillo PA (2006) A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve. Int J Colorectal Dis 21(6):590–595CrossRefGoogle Scholar
  26. 26.
    Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 49(8):1108–1115PubMedCrossRefGoogle Scholar
  27. 27.
    Ortiz H, Ciga MA, Oteiza F, Armendariz P, De MM, Marzo J (2006) Introduction of laparoscopy in the treatment of rectal cancer in a coloproctology unit. Cir Esp 79(3):160–166PubMedCrossRefGoogle Scholar
  28. 28.
    Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di CV (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50(4):464–471PubMedCrossRefGoogle Scholar
  29. 29.
    Noblett SE, Horgan AF (2007) A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection. Surg Endosc 21(3):404–408PubMedCrossRefGoogle Scholar
  30. 30.
    Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91(9):1111–1124PubMedCrossRefGoogle Scholar
  31. 31.
    Schwenk W, Bohm B, Haase O, Junghans T, Muller JM (1998) Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 383(1):49–55PubMedCrossRefGoogle Scholar
  32. 32.
    Stage JG, Schulze S, Moller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielsen HJ (1997) Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 84(3):391–396PubMedCrossRefGoogle Scholar
  33. 33.
    Schwenk W, Bohm B, Witt C, Junghans T, Grundel K, Muller JM (1999) Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134(1):6–12PubMedCrossRefGoogle Scholar
  34. 34.
    Schwenk W, Jacobi C, Mansmann U, Bohm B, Muller JM (2000) Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial. Langenbecks Arch Surg 385(1):2–9PubMedCrossRefGoogle Scholar
  35. 35.
    Ordemann J, Jacobi CA, Schwenk W, Stosslein R, Muller JM (2001) Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Surg Endosc 15(6):600–608PubMedCrossRefGoogle Scholar
  36. 36.
    Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F (2001) Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg 88(6):801–807PubMedCrossRefGoogle Scholar
  37. 37.
    Lacy AM, Delgado S, Garcia-Valdecasas JC, Castells A, Pique JM, Grande L, Fuster J, Targarona EM, Pera M, Visa J (1998) Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc 12(8):1039–1042PubMedCrossRefGoogle Scholar
  38. 38.
    Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89(12):1551–1556PubMedCrossRefGoogle Scholar
  39. 39.
    Feliciotti F, Guerrieri M, Paganini AM, De SA, Campagnacci R, Perretta S, D’Ambrosio G, Lezoche E (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17(10):1530–1535PubMedCrossRefGoogle Scholar
  40. 40.
    Jane D (2009) Chirurgia Laparoscopica del Colon. Il Sole 24 ORE - Sanità, 10-12Google Scholar
  41. 41.
    Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13(3):413–424PubMedCrossRefGoogle Scholar
  42. 42.
    HAS Haute Autorité de Santé (2005) Coelioscopie en chirurgie du cancer colorectalGoogle Scholar
  43. 43.
    King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93(3):300–308PubMedCrossRefGoogle Scholar
  44. 44.
    Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, Jeekel J, Pahlman L, Morino M, Lacy A et al (2005) Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc 19(5):687–692PubMedCrossRefGoogle Scholar
  45. 45.
    Neudecker J, Junghans T, Raue W, Ziemer S, Schwenk W (2005) Fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resection: data from a randomized controlled trial. Langenbecks Arch Surg 390(6):523–527PubMedCrossRefGoogle Scholar
  46. 46.
    NICE (2006) Colorectal cancer - laparoscopic surgery (review)Google Scholar
  47. 47.
    Simons AJ, Anthone GJ, Ortega AE, Franklin M, Fleshman J, Geis WP, Beart RW Jr (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38(6):600–603PubMedCrossRefGoogle Scholar
  48. 48.
    Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91PubMedCrossRefGoogle Scholar
  49. 49.
    Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW Jr (1997) The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132(1):41–44PubMedCrossRefGoogle Scholar
  50. 50.
    Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 44(2):217–222PubMedCrossRefGoogle Scholar
  51. 51.
    Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46(10):1371–1378PubMedCrossRefGoogle Scholar
  52. 52.
    Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery. Do we get faster? Surg Endosc 11(4):331–335PubMedCrossRefGoogle Scholar
  53. 53.
    Berto P (2010) HTA e valutazioni economiche. In: De Rosa M, Scroccaro G (eds) Applicazione delle tecniche HTA alla valutazione di Farmaci e Dispositivi Medici. Multimedia, MilanoGoogle Scholar
  54. 54.
    Torbica A, Tarricone R, Calciolari S, Branca V, Gaini M (2009) Analisi dei costi del trattamento dell’aneurisma intracranico in Italia. Pharmacoecon Ital Res Articles 11(1):25–37Google Scholar
  55. 55.
    SIMS/SUMAI (2006) Tempi Medi di Attività Modalità di Esecuzione Nomenclatore delle Prestazioni Specialistiche Ambulatoriali Territoriali; Prima EdizioneGoogle Scholar
  56. 56.
    GIOFIL (2009) Prontuario Farmaci del Sistema Sanitario Nazionale, July 20Google Scholar
  57. 57.
    Ministero della Salute (2006) Aggiornamento delle tariffe delle prestazioni di assistenza ospedaliera. Decreto Ministeriale, Dec 13Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Patrizia Berto
    • 1
    Email author
  • Stefania Lopatriello
    • 1
  • Andrea Aiello
    • 1
  • Francesco Corcione
    • 2
  • Giuseppe Spinoglio
    • 3
  • Vincenzo Trapani
    • 4
  • Gianluigi Melotti
    • 4
  1. 1.PBE Consulting SRLVeronaItaly
  2. 2.General Surgery UnitMonaldi HospitalNaplesItaly
  3. 3.General Surgery UnitAlessandria City HospitalAlessandriaItaly
  4. 4.General Surgery UnitS. Agostino HospitalModenaItaly

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