Financial Comparison of Laparoscopic Versus Open Hepatic Resection Using Deviation-Based Cost Modeling

Abstract

The cost-effectiveness of laparoscopic hepatectomy appears to vary with the complexity of the procedure. Overall, laparoscopy offers a cost advantage; however, with more complex procedures such as right hepatectomy, higher up-front operating room charges offset the financial benefits of less complicated hospitalization.

The comparative costs of laparoscopic and open liver resection: a report for the 2nd International Consensus Conference on Laparoscopic Liver Resection

“…Methodologies included retrospective reviews and case-matched series. Two publications [11,12] used a deviation-based cost modeling (DBCM), which measures the occurrence and severity of complications that deviate from the normal postoperative course and the financial implications of these deviations. Nine series described a predominantly pure laparoscopic approach to hepatic resection, while one center [13] employed a hand-assisted laparoscopic approach for all cases.…”

“…Abu Hilal et al [17] provided separate comparisons for LLLS versus OLLS and open (ORH) versus laparoscopic right hepatectomy (LRH). Two papers included a mix of minor and major hepatectomy [12,18], while Medbery et al [13] analyzed outcomes for right hepatectomy only. Among the 11 publications, cost analyses for 306 minor and 137 major laparoscopic hepatic resections are considered.…”

“…Three manuscripts either explicitly excluded converted cases or were not included in the analysis [15,19,20], while one manuscript analyzed converted cases in the open group [12]. In the remaining manuscripts, converted cases were considered on an intention-totreat basis and were analyzed in the laparoscopic group.…”

Laparoscopic liver resection

“…12 This cost savings was confirmed in a more recent study for hand-assisted laparoscopic hepatic resections, with financial savings of up to $11,000. 13 Several centers have also reported use of the robot for laparoscopic liver resection. The Pittsburgh group reported 57 robotic liver resections that were case-cohort matched to 114 laparoscopic resections and showed that the use of the robot resulted in less need for a hand port, hybrid technique, or conversion to an open procedure.…”

The financial burden of cancer care: do patients in the US know what to expect?

“…Lung cancer surgery is estimated to cost approximately US$20,000 [23]. Costs of a standard course of radiation therapy for breast cancer are over US$10,000 [24]. Many patients receive surgery and radiation, and these costs do not include diagnostic imaging, pathology or management of complications from disease or treatment (such as infections, bowel obstruction, bone fractures).…”