Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer.
OBJECTIVE
Colorectal cancer is one of the most common cancers and the standard surgical treatment for this cancer is open resection (OS), but laparoscopic surgery (LS) may be an alternative treatment. In 2000, a Health Technology Assessment (HTA) review found little evidence on costs and cost-effectiveness in comparing the two methods. The evidence base has since expanded and this study systematically reviews the economic evaluations on the subject published since 2000.


METHODS
Systematic review of studies reporting costs and outcomes of LS vs OS for colorectal cancer. National Health Service Economic Evaluation Database (NHS EED) methods for abstract writing were followed. Studies were summarized and incremental cost-effectiveness ratios (ICER) for common outcomes were calculated.


RESULTS
Five studies met the inclusion criteria. LS generally had higher healthcare costs. Most studies reported longer operational time and shorter length of stay and similar long-term outcomes with LS vs OS. Only one outcome, complications, was common across all studies but results lacked consistency (e.g. in two studies, OS was less costly but more effective; in another study, LS was less costly but more effective; and in the further two studies, LS could potentially be cost effective depending on the decision-makers' willingness to pay for the health gain).


CONCLUSIONS
The evidence on cost-effectiveness is not consistent. LS was generally more costly than OS. However, the effectiveness data used in individual economic evaluation were imprecise and unreliable when compared with data from systematic reviews of effectiveness. Nevertheless, short-term benefits of LS (e.g. shorter recovery) may make LS appear less costly when productivity gains are considered.
Hernández
R A
RA
Health Economics Research Unit, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, Scotland, UK.
de Verteuil
R M
RM
Fraser
C M
CM
Vale
L D
LD
D015179:Colorectal Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome