The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial.
BACKGROUND
Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented.


METHODS
An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection (LSR) to open sigmoid resection (OSR) in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient. To avoid distributional assumptions, the nonparametric bootstrap was applied. For the cost-effectiveness analysis, differences in total cost between LSR and OSR were compared with the differences in VAS pain score, SF-36 values for general health, and complication rate.


RESULTS
The difference in total healthcare costs between the group that received LSR (euro 9969) and the group that received OSR (euro 9366) was not statistically significant. The slight increase in total costs was determined mainly by the significantly higher operation costs of LSR (euro 6663 vs. euro 5306). Lower costs for hospitalization (euro 2983 vs. euro 3598), blood products (euro 87 vs. euro 240), paramedical services (euro 157 vs. euro 278), and emergency attendance (euro 72 vs. euro 115) in the LSR group partially compensated these increased operation costs. The incremental cost-effectiveness ratios (ICER) indicate that improvements in pain, quality of life, and complication rate could be achieved at limited costs.


CONCLUSIONS
Total healthcare costs of laparoscopic and open elective sigmoid resections for symptomatic diverticular disease are similar. As the clinical outcomes are in favor of the LSR group, candidates for an elective sigmoid resection should preferably be approached laparoscopically.
Klarenbeek
Bastiaan R
BR
Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. br.klarenbeek@vumc.nl
Coupé
Veerle M H
VM
van der Peet
Donald L
DL
Cuesta
Miguel A
MA
D000488:Allied Health Personnel / Q000191:economics; D001803:Blood Transfusion / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data; D004238:Diverticulitis / Q000601:surgery*; D004241:Diverticulum, Colon / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics; D017048:Health Care Costs; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007813:Laparotomy / Q000191:economics; D010564:Personnel, Hospital / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011300:Preoperative Care / Q000191:economics; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012810:Sigmoid Diseases / Q000601:surgery*