Laparoscopic appendicectomy: calculating the cost.
BACKGROUND
Laparoscopic appendicectomy is a commonly performed procedure presenting a considerable cost burden. Given the additional operative costs of laparoscopic versus open appendicectomy, it is not clear whether the national tariffs are appropriate for laparoscopic appendicectomy. We conducted a study to establish the institutional costs, and to determine whether re-imbursement according to the national tariffs was sufficient.


METHODS
Data were collected prospectively on patients undergoing laparoscopic appendicectomy within Leeds Teaching Hospitals Trust. Theatre and bed costs were obtained. Cost analysis was performed, and costs were compared to the re-imbursement due.


RESULTS
Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was pound906. Median equipment cost for laparoscopically completed cases was pound254. Median total in-patient cost was pound1617 (range, pound880- pound3360). This compared with a mean re-imbursement of pound1981 representing a cost benefit of pound233 per case (P = 0.0009).


CONCLUSIONS
Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols.
Needham
P J
PJ
Department of Colorectal Surgery, Leeds General Infirmary, Great George Street, Leeds, UK. pneedham@gmail.com
Laughlan
K A
KA
Botterill
I D
ID
Ambrose
N S
NS
D000328:Adult; D001062:Appendectomy / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004739:England; D018588:Fee-for-Service Plans; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D011446:Prospective Studies