Laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma: cost-effectiveness analysis. Issue 5 (6th August 2020)

• Record Type: Journal Article
• Authors: Gosselin-Tardif, A; Abou-Khalil, M; Mata, J; Guigui, A; Cools-Lartigue, J; Ferri, L; Lee, L; Mueller, C
• Is Part Of: BJS open. Volume 4:Issue 5(2020)
• Page Start: 830
• Page End: 839
• Publication Date: 2020-08-06
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50327
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Laparoscopic subtotal gastrectomy (LSG) for cancer is associated with good perioperative outcomes and superior quality of life compared with the open approach, albeit at higher cost. An economic evaluation was conducted to compare the two approaches. Methods: A cost–effectiveness analysis between LSG and open subtotal gastrectomy (OSG) for gastric cancer was performed using a decision-tree cohort model with a healthcare system perspective and a 12-month time horizon. Model inputs were informed by a meta-analysis of relevant literature, with costs represented in 2016 Canadian dollars (CAD) and outcomes measured in quality-adjusted life-years (QALYs). A secondary analysis was conducted using inputs extracted solely from European and North American studies. Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results: In the base-case model, costs of LSG were $935 (€565) greater than those of OSG, with an incremental gain of 0·050 QALYs, resulting in an incremental cost–effectiveness ratio of $18 846 (€11 398) per additional QALY gained from LSG. In the DSA, results were most sensitive to changes in postoperative utility, operating theatre and equipment costs, as well as duration of surgery and hospital stay. PSA showed that the likelihood of LSG being cost-effective at willingness-to-pay thresholds of $50 000 (€30 240) per QALY and $100 000 (€60 480) per QALY was 64 and 68 per cent respectively. Secondary analysis using European and North American clinical inputs resulted in LSG being dominant (cheaper and more effective) over OSG, largely due to reduced length of stay after LSG. Conclusion: In this decision analysis model, LSG was cost-effective compared with OSG for gastric cancer. Graphical Abstract: Laparoscopic subtotal gastrectomy (LSG) is associated with good perioperative outcomes and superior quality of life compared with the open approach to resection of gastric adenocarcinoma, albeit at higher cost. A cost–effectiveness analysis comparing the two approaches found LSG to be cost-effective compared with the open approach, with an incremental cost–effectiveness ratio of $18 846 per quality-adjusted life-year. In a secondary analysis of studies from Europe and North America, where reduction in duration of hospital stay after laparoscopic gastrectomy is greater, the minimally invasive approach became dominant (both cheaper and more effective) in comparison with open gastrectomy. OR, operating room; LOS, length of hospital stay. Analysis favours laparoscopic approach