Retroperitoneal endoscopic versus conventional open adrenalectomy: a cost-effectiveness analysis.
BACKGROUND
A retrospective cost-effectiveness analysis was carried out, comparing retroperitoneal endoscopic and conventional adrenalectomy, which is based on a large group of patients, restricted in tumor size for the purpose of ensuring comparability.


METHODS
Between 1990 and 2004, 61 patients underwent either an endoscopic or open adrenalectomy for tumors smaller than 6 cm. A short-term, base cost-effectiveness analysis was performed to evaluate costs per day prevented, and a sensitivity analysis was calculated.


RESULTS
Average recovery time, postoperative stay, and resumption to oral intake were significantly shorter in the endoscopic group, whereas operative time was longer. No major complications occurred in either group. In 3 endoscopic procedures conversion was indicated. The base cost-effectiveness ratio was 15.41 per day postoperative stay prevented by the endoscopic approach. The number needed to treat with endoscopic adrenalectomy to prevent 1 week of postoperative stay is 2.


CONCLUSIONS
Retroperitoneal endoscopic adrenalectomy may be considered a cost-effective procedure, compared to the conventional open adrenalectomy.
Schreinemakers
Jennifer M J
JM
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Elias
Sjoerd G
SG
Borel Rinkes
Inne H M
IH
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000191:economics* / Q000379:methods*; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric