title: Diagnostic laparoscopy for patients with potentially resectable pancreatic adenocarcinoma: is it cost-effective in the current era?
abstract: BACKGROUND
  For patients with potentially resectable pancreatic cancer, diagnostic laparoscopy may identify liver and peritoneal metastases that are difficult to detect with other staging modalities. The aim of this study was to utilize a population-based pancreatic cancer database to assess the cost effectiveness of preoperative laparoscopy.
  
  
  METHODS
  Data from a state cancer registry were linked with primary medical record data for years 1996-2003. De-identified patient records were reviewed to determine the role and findings of laparoscopic exploration. Average hospital and physician charges for laparotomy, biliary bypass, pancreaticoduodenectomy, and laparoscopy were determined by review of billing data from our institution and Medicare data for fiscal years 2005-2006. Cost-effectiveness was determined by comparing three methods of utilization of laparoscopy: (1) routine (all patients), (2) case-specific, and (3) no utilization.
  
  
  CONCLUSIONS
  Of 298 potentially resectable patients, 86 underwent laparoscopy. The prevalence of unresectable disease was 14.1% diagnosed at either laparotomy or laparoscopy. The mean charge per patient for routine, case-specific, and no utilization of laparoscopy was $91,805, $90,888, and $93,134, respectively.
  
  
  CONCLUSIONS
  Cost analysis indicates that the case-specific or routine use of laparoscopy in pancreatic cancer does not add significantly to the overall expense of treatment and supports the use of laparoscopy in patients with known or suspected pancreatic adenocarcinoma.
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Enestvedt
authors.forename: S C
authors.initials: SC
authors.lastname: Mayo
authors.forename: B S
authors.initials: BS
authors.lastname: Diggs
authors.forename: M
authors.initials: M
authors.lastname: Mori
authors.forename: D A
authors.initials: DA
authors.lastname: Austin
authors.forename: D K
authors.initials: DK
authors.lastname: Shipley
authors.forename: B C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: K G
authors.initials: KG
authors.lastname: Billingsley
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics / Q000379:methods; D009922:Oregon; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D011300:Preoperative Care / Q000191:economics / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies