Economic evaluation of laparoscopic surgery for colorectal cancer.
OBJECTIVE
The aim of this study was to assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer.


METHODS
A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life-year gained and using cost-effectiveness acceptability curves to illustrate the likelihood that a treatment was cost-effective at various threshold values for society's willingness to pay for an additional life-year.


RESULTS
Laparoscopic surgery was on average pounds 300 more costly and slightly less effective than open surgery and had a 30 percent chance of being cost-effective if society is willing to pay pounds 30,000 for a life-year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality-adjusted life-year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits after laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective.


CONCLUSIONS
Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes, and an additional pounds 300 per patient. A judgment is required as to whether the short-term benefits are worth this extra cost.
de Verteuil
Robyn M
RM
University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom. r.deverteuil@abdn.ac.uk
Hernández
Rodolfo A
RA
Vale
Luke
L
D015179:Colorectal Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical; D006113:United Kingdom