Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

Abstract

ObjectivesLaparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients’ health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass.Patients and methodsThis was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay.ResultsWe found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), (p=0.001).ConclusionLaparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.

Quality of Life (QoL) Assessment in the Patients Operated with Either Laparoscopic or an Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease (AIOD): 2 Years Results of a Randomized Controlled Trial

“…EQ-5D questionnaires are simple, and it takes a shorter time to be answered by the patients. 29 , 30 …”

<p>A Short Series of Laparoscopic Mesenteric Bypasses for Chronic Mesenteric Ischemia</p>

“…This is even though the operating team has a long experience with laparoscopic aortic surgery. [17][18][19] Nevertheless, the previous experience did help during the construction of anastomosis. We experienced that when the operative field for the anastomosis construction was once achieved, the laparoscopic anastomosis could be performed within an acceptable time, as reflected in our results ( Table 2).…”

<p>Cost comparison analysis of laparoscopic versus open aortobifemoral bypass surgery: a randomized controlled trial</p>

“…We have in our previous randomized study found that the LABFB was more costeffective than the OABFB procedure. 12 However, we had utilized national data for cost per day in hospital for the economic evaluations. 22 The national data for cost per day in a somatic hospital is based on the average cost of a single hospital day in all the somatic hospital admissions.…”

“…The rapid and widespread introduction of laparoscopic technique in different fields of surgery has shown to have implications for health-care costs. 12,13 The cost of health services will be affected by minimal-access treatment, due to reduced hospital stay and change in operating time, particularly when a new technique is introduced. 8 The advantages and disadvantages of each new technology need to be evaluated in terms of resources used, in form of equipment, time and administrative costs.…”