Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial

Abstract

Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Objective. To determine the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in early stage endometrial cancer alongside a multicenter randomised controlled trial (RCT).Methods. An economic analysis was conducted in 279 patients (TLH n = 185; TAH n = 94) with early stage endometrial cancer from a societal perspective, including all relevant costs over a three month time horizon. Health outcomes were expressed in terms of major complication-free rate and in terms of utility based on women's response to the EQ-5D. Comparisons of costs per major complication-free patient gained and costs with utility gain and costs were made, using incremental cost effectiveness ratios.Results. The mean major complication-free rate and median utility scores were comparable between TLH and TAH at three months. TLH is more costly intraoperatively (Δ$1.129) and less costly postoperatively inhospital (Δ$−1.350) compared to TAH. Incremental costs per major complication-free patient were $−52. Higher cost ($249) were generated while no gains in utility (−0.02) were observed for TLH compared to TAH. Analysing utility at six weeks, incremental costs per additional point on the EQ-5D scale were $1.617.Conclusion. TLH is cost effective compared to TAH, based on major complication-free rate as measure of effect. Along with future cost saving strategies in laparoscopy, TLH is assumed to be cost effective for both effect measures. Therefore and due to comparable safety, TLH should be recommended as a standard-of-care surgical procedure in early endometrial cancer.

The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer

“…As a result of shorter hospitalization, for many patients, total laparoscopic hysterectomy (TLH) is likely to be more cost effective to society than TAH in terms of incremental costs per complication-free patient—however, this may not be the case in obese patients with BMI > 35 due to high laparotomy conversion rates [9, 10]. Robot assisted total laparoscopic hysterectomy (TRH) is an increasingly available alternative that may confer an advantage in obese and other complex patients by lowering the need for conversion.…”

Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy in Obese Women With Early-Stage Cervical Cancer

“…30 This study has not investigated the cost implications of the TLRH compared to the RAH. However, we have shown that the TLRH is a surgically safe procedure in obese women when performed by an experienced surgical and anesthetic team with the appropriate equipment.…”

Society of gynecologic oncology future of physician payment reform task force: Lessons learned in developing and implementing surgical alternative payment models

“…Using methods described in the companion paper, the PPRTF compared the current ("status quo") costs of care to the costs that might be incurred in various alternative ("optimal") scenarios [14]. Three potential areas of cost savings were examined: increasing the rate of minimally invasive hysterectomy; reducing length of stay; and decreasing readmissions/emergency department visits [15][16][17][18][19][20][21][22]. The PPRTF modeled a scenario incorporating favorable changes in all three parameters.…”