A prospective cohort study to investigate cost-minimisation, of Traditional open, open fAst track recovery and laParoscopic fASt track multimodal management, for surgical patients with colon carcinomas (TAPAS study).
BACKGROUND
The present developments in colon surgery are characterized by two innovations: the introduction of the laparoscopic operation technique and fast recovery programs such as the Enhanced Recovery After Surgery (ERAS) recovery program. The Tapas-study was conceived to determine which of the three treatment programs: open conventional surgery, open 'ERAS' surgery or laparoscopic 'ERAS' surgery for patients with colon carcinomas is most cost minimizing?


METHODS
The Tapas-study is a three-arm multicenter prospective cohort study. All patients with colon carcinoma, eligible for surgical treatment within the study period in four general teaching hospitals and one university hospital will be included. This design produces three cohorts: Conventional open surgery is the control exposure (cohort 1). Open surgery with ERAS recovery (cohort 2) and laparoscopic surgery with ERAS recovery (cohort 3) are the alternative exposures. Three separate time periods are used in order to prevent attrition bias. Primary outcome parameters are the two main cost factors: direct medical costs (real cost price calculation) and the indirect non medical costs (friction method). Secondary outcome parameters are mortality, complications, surgical-oncological resection margins, hospital stay, readmission rates, time back to work/recovery, health status and quality of life. Based on an estimated difference in direct medical costs (highest cost factor) of 38% between open and laparoscopic surgery (alfa = 0.01, beta = 0.05), a group size of 3 x 40 = 120 patients is calculated.


CONCLUSIONS
The Tapas-study is three-arm multicenter cohort study that will provide a cost evaluation of three treatment programs for patients with colon carcinoma, which may serve as a guideline for choice of treatment and investment strategies in hospitals.


BACKGROUND
ISRCTN44649165.
Reurings
Jurrian C
JC
Department of Surgery, Sint Elisabeth Hospital, Tilburg, the Netherlands.
Spanjersberg
Willem R
WR
Oostvogel
Henk J M
HJ
Buskens
Erik
E
Maring
John
J
Kruijt
Flip
F
Rosman
Camiel
C
van Duivendijk
Peter
P
Dejong
Cees H C
CH
van Laarhoven
Cees J H M
CJ
D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003082:Colectomy / Q000191:economics / Q000379:methods; D003110:Colonic Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003113:Colonoscopy / Q000191:economics / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007813:Laparotomy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome