Skip to main content
Erschienen in: Surgical Endoscopy 4/2017

18.08.2016

Real-world cost-effectiveness of laparoscopy versus open colectomy for colon cancer: a nationwide population-based study

verfasst von: Chih-Hsien Liao, Elise Chia-Hui Tan, Chien-Chih Chen, Ming-Chin Yang

Erschienen in: Surgical Endoscopy | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Laparoscopic colectomy is increasingly being adopted for the treatment of colon cancer; however, the long-term effectiveness of this approach in a real-world clinical setting has yet to be verified. This study aims to compare the effectiveness and costs associated with laparoscopic and open colectomy from the perspective of the National Health Insurance (NHI) system in Taiwan.

Methods

A nationwide population-based colon cancer cohort was observed by linking the Taiwan Cancer Registry, claims data from NHI system, and the National Death Registry. Adult patients with Stage I to Stage III colon cancer who underwent primary cancer resection using either laparoscopy or open colectomy between 2009 and 2011 were included. A propensity score-matched cohort (1745 pairs) was applied to examine three clinical endpoints: overall survival, recurrence-free survival, and disease-free survival within 2 years after the operation. To comply with the perspective as well as the analytic horizon of the study, we limited the research to NHI claims from the study population for the corresponding time period. The health outcomes and net monetary benefits were verified by multivariate mixed-effect models.

Results

This analysis revealed that laparoscopy resulted in longer overall survival (adjusted difference 16.8 days, 95 % CI 7.3–26.2), recurrence-free survival (16.8 days, 5.0–28.6) and disease-free survival (26.4 days, 7.4–45.4), compared to open colectomy at 2 years post-op. Laparoscopy also led to a significantly shorter length of stay (3.2 days, 2.4–3.9) and lower index hospitalization costs (US$ 455, 181–729) than open colectomy; however, no differences in costs were observed over the long term. Overall, laparoscopy was more cost-effective than open colectomy under various willingness-to-pay thresholds in the setting of the Taiwan NHI.

Conclusions

The continued adoption of laparoscopy in primary curable colon cancer resection is expected to reduce health care costs over the short term while providing considerable health benefits over the long term.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, Ferri M (2014) Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 20:3680–3692CrossRefPubMedPubMedCentral Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, Ferri M (2014) Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 20:3680–3692CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMed Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMed
3.
Zurück zum Zitat Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMed Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMed
4.
Zurück zum Zitat Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662 (discussion 662–654) CrossRefPubMed Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662 (discussion 662–654) CrossRefPubMed
5.
Zurück zum Zitat Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
6.
Zurück zum Zitat Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR (2012) Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256:915–919CrossRefPubMed Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR (2012) Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256:915–919CrossRefPubMed
7.
Zurück zum Zitat Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7CrossRefPubMed Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7CrossRefPubMed
8.
Zurück zum Zitat 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 (London, England) 359:2224–2229CrossRef 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 (London, England) 359:2224–2229CrossRef
9.
Zurück zum Zitat Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A (2013) Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg 37:2458–2467CrossRefPubMed Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A (2013) Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg 37:2458–2467CrossRefPubMed
10.
Zurück zum Zitat Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11:323–326CrossRefPubMedPubMedCentral Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11:323–326CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Vaid S, Tucker J, Bell T, Grim R, Ahuja V (2012) Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database. Am Surg 78:635–641PubMed Vaid S, Tucker J, Bell T, Grim R, Ahuja V (2012) Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database. Am Surg 78:635–641PubMed
12.
Zurück zum Zitat Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149:177–184CrossRefPubMedPubMedCentral Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149:177–184CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat 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 91:409–417CrossRefPubMed 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 91:409–417CrossRefPubMed
14.
Zurück zum Zitat Hernandez RA, de Verteuil RM, Fraser CM, Vale LD (2008) Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer. Colorectal Dis 10:859–868PubMed Hernandez RA, de Verteuil RM, Fraser CM, Vale LD (2008) Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer. Colorectal Dis 10:859–868PubMed
15.
Zurück zum Zitat Aly OE, Quayyum Z (2012) Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 27:855–860CrossRefPubMed Aly OE, Quayyum Z (2012) Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 27:855–860CrossRefPubMed
17.
Zurück zum Zitat Renehan AG, Egger M, Saunders MP, O’Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. Br Med J 324:813CrossRef Renehan AG, Egger M, Saunders MP, O’Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. Br Med J 324:813CrossRef
18.
Zurück zum Zitat Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ (2005) Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 23:8512–8519CrossRefPubMed Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ (2005) Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 23:8512–8519CrossRefPubMed
19.
Zurück zum Zitat Guyot F, Faivre J, Manfredi S, Meny B, Bonithon-Kopp C, Bouvier AM (2005) Time trends in the treatment and survival of recurrences from colorectal cancer. Ann Oncol 16:756–761CrossRefPubMed Guyot F, Faivre J, Manfredi S, Meny B, Bonithon-Kopp C, Bouvier AM (2005) Time trends in the treatment and survival of recurrences from colorectal cancer. Ann Oncol 16:756–761CrossRefPubMed
20.
Zurück zum Zitat Punt CJ, Buyse M, Kohne CH, Hohenberger P, Labianca R, Schmoll HJ, Pahlman L, Sobrero A, Douillard JY (2007) Endpoints in adjuvant treatment trials: a systematic review of the literature in colon cancer and proposed definitions for future trials. J Natl Cancer Inst 99:998–1003CrossRefPubMed Punt CJ, Buyse M, Kohne CH, Hohenberger P, Labianca R, Schmoll HJ, Pahlman L, Sobrero A, Douillard JY (2007) Endpoints in adjuvant treatment trials: a systematic review of the literature in colon cancer and proposed definitions for future trials. J Natl Cancer Inst 99:998–1003CrossRefPubMed
21.
Zurück zum Zitat Hoch JS, Briggs AH, Willan AR (2002) Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 11:415–430CrossRefPubMed Hoch JS, Briggs AH, Willan AR (2002) Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 11:415–430CrossRefPubMed
22.
Zurück zum Zitat Allaix ME, Giraudo G, Mistrangelo M, Arezzo A, Morino M (2015) Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial. Surg Endosc 29:916–924CrossRefPubMed Allaix ME, Giraudo G, Mistrangelo M, Arezzo A, Morino M (2015) Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial. Surg Endosc 29:916–924CrossRefPubMed
23.
Zurück zum Zitat Damle RN, Macomber CW, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, Maykel JA, Santry HP, Alavi K (2014) Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg 218:1223–1230CrossRefPubMedPubMedCentral Damle RN, Macomber CW, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, Maykel JA, Santry HP, Alavi K (2014) Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg 218:1223–1230CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Drolet S, MacLean AR, Myers RP, Shaheen AA, Dixon E, Buie WD (2011) Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality. J Gastroint Surg 15:541–550CrossRef Drolet S, MacLean AR, Myers RP, Shaheen AA, Dixon E, Buie WD (2011) Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality. J Gastroint Surg 15:541–550CrossRef
25.
Zurück zum Zitat Thompson BS, Coory MD, Gordon LG, Lumley JW (2014) Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc 28:1515–1521CrossRefPubMed Thompson BS, Coory MD, Gordon LG, Lumley JW (2014) Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc 28:1515–1521CrossRefPubMed
26.
Zurück zum Zitat Ramji KM, Cleghorn MC, Josse JM, MacNeill A, O’Brien C, Urbach D, Quereshy FA (2016) Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc 30:1337–1343CrossRefPubMed Ramji KM, Cleghorn MC, Josse JM, MacNeill A, O’Brien C, Urbach D, Quereshy FA (2016) Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc 30:1337–1343CrossRefPubMed
27.
Zurück zum Zitat Keller DS, Delaney CP, Hashemi L, Haas EM (2015) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. doi:10.1007/s00464-015-4732-6 Keller DS, Delaney CP, Hashemi L, Haas EM (2015) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. doi:10.​1007/​s00464-015-4732-6
28.
Zurück zum Zitat Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastroint Surg 12:583–591CrossRef Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastroint Surg 12:583–591CrossRef
Metadaten
Titel
Real-world cost-effectiveness of laparoscopy versus open colectomy for colon cancer: a nationwide population-based study
verfasst von
Chih-Hsien Liao
Elise Chia-Hui Tan
Chien-Chih Chen
Ming-Chin Yang
Publikationsdatum
18.08.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 4/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5176-3

Weitere Artikel der Ausgabe 4/2017

Surgical Endoscopy 4/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.