Abstract
Background
Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented.
Methods
An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection (LSR) to open sigmoid resection (OSR) in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient. To avoid distributional assumptions, the nonparametric bootstrap was applied. For the cost-effectiveness analysis, differences in total cost between LSR and OSR were compared with the differences in VAS pain score, SF-36 values for general health, and complication rate.
Results
The difference in total healthcare costs between the group that received LSR (€ 9969) and the group that received OSR (€ 9366) was not statistically significant. The slight increase in total costs was determined mainly by the significantly higher operation costs of LSR (€ 6663 vs. € 5306). Lower costs for hospitalization (€ 2983 vs. € 3598), blood products (€ 87 vs. € 240), paramedical services (€ 157 vs. € 278), and emergency attendance (€ 72 vs. € 115) in the LSR group partially compensated these increased operation costs. The incremental cost-effectiveness ratios (ICER) indicate that improvements in pain, quality of life, and complication rate could be achieved at limited costs.
Conclusion
Total healthcare costs of laparoscopic and open elective sigmoid resections for symptomatic diverticular disease are similar. As the clinical outcomes are in favor of the LSR group, candidates for an elective sigmoid resection should preferably be approached laparoscopically.
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References
Parks TG (1969) Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J 4:639–642
Chapman JR, Dozois EJ, Wolff BG, Gullerud RE, Larson DR (2006) Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg 243:876–830
Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122:1500–1511
Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249:210–217
Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 357:2057–2066
Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944
Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92:133–142
Hjern F, Josephson T, Altman D, Holmstrom B, Johansson C (2008) Outcome of younger patients with acute diverticulitis. Br J Surg 95:758–764
Morris CR, Harvey IM, Stebbings WS, Hart AR (2008) Incidence of perforated diverticulitis and risk factors for death in a UK population. Br J Surg 95:876–881
Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92:1520–1525
Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbecks Arch Surg 389:97–103
Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Barlehner E, Pross M, Schmidt U, Kockerling F, Lippert H (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients. Dis Colon Rectum 47:1883–1888
Klarenbeek BR, Veenhof AA, de Lange ES, Bemelman WA, Bergamaschi R, Heres P, Lacy AM, van den Broek WT, van der Peet DL, Cuesta MA (2007) The Sigma-trial protocol: a prospective double-blind multi-centre comparison of laparoscopic versus open elective sigmoid resection in patients with symptomatic diverticulitis. BMC Surg 7:16
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249:39–44
Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50:908–919
Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45:485–490
Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs. traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 10:15–18
Kohler L, Rixen D, Troidl H (1998) Laparoscopic colorectal resection for diverticulitis. Int J Colorectal Dis 13:43–47
Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236
Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320:1197–1200
Briggs AH, Wonderling DE, Mooney CZ (1997) Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 6:327–340
Briggs A, Fenn P (1998) Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ 7:723–740
Coupé VM, Veenhof C, van Tulder MW, Dekker J, Bijlsma JW, van den Ende CH (2007) The cost effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee. Ann Rheum Dis 66:215–221
Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E (1998) Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 51:1055–1068
Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45:605–610
Kohler L, Holthausen U, Troidl H (1997) Laparoscopic colorectal surgery–attempt at evaluating a new technology. Chirurg 68:794–800
Pfeifer J, Wexner SD, Reissman P, Bernstein M, Nogueras JJ, Singh S, Weiss E (1995) Laparoscopic vs open colon surgery. Costs and outcome. Surg Endosc 9:1322–1326
Acknowledgment
We thank Meike van Haastert and Koen Meijssen from the Department of Information and Management for their contribution to the collection of resource utilization and the translation into costs.
Disclosures
B. R. Klarenbeek, V. M. H. Coupé, D. L. van der Peet, and M. A. Cuesta have no conflicts of interest or financial ties to disclose.
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Klarenbeek, B.R., Coupé, V.M.H., van der Peet, D.L. et al. The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial. Surg Endosc 25, 776–783 (2011). https://doi.org/10.1007/s00464-010-1252-2
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DOI: https://doi.org/10.1007/s00464-010-1252-2