Direct and indirect costs and long-term survival of laparoscopic anterior resection for rectal cancer.
BACKGROUND
Few studies evaluate the cost-effectiveness issues of laparoscopic anterior resection (LAR) for rectal cancer. This study evaluates direct and indirect costs of LAR and its long-term survival rate in rectal cancer patients.


METHODS
This prospective nonrandomized controlled trial included 2 endpoints (direct and indirect costs, and disease-free survival). From January 2003 to May 2005, rectal cancer patients admitted to our center were assigned to 2 groups: 87 patients underwent LAR (LAP), while 86 cases received open anterior resection (OPEN). The direct costs were prospectively evaluated. Main indirect cost is productivity loss. The data of direct costs, indirect costs, and the total costs were collected for the minimal cost analysis.


RESULTS
Disease-free survival at 65 months in the LAP group and the OPEN group was 78.2% and 74.7%; there was no significant difference between the groups. Median direct costs were not significantly different between the LAP and the OPEN groups. Indirect costs of the LAP group were significantly lower than those of the OPEN group, while total costs were not significantly different. Cost percentage for operations, medications, and hospitalization were 75.90%, 11.28%, and 2.18% in the LAP group; while in the operation group, they were 54.50%, 29.09%, and 3.35%.


CONCLUSIONS
Total economic budget for a patient receiving LAR was not significantly increased compared with the conservative method owing to its technical predominance, oncologic safety, as well as frequent bed turnover.
Department of Surgery, Ruijin Hospital, Shanghai Minimally Invasive Surgery Center, Shanghai Jiaotong University, School of Medicine, Shanghai, P. R. China.
Bo
B
Feng
Qian-Lin
QL
Zhu
Yi
Y
Xia
Ai-Guo
AG
Lu
Ming-Liang
ML
Wang
Jian-Wen
JW
Li
Wei-Guo
WG
Hu
Lu
L
Zang
Zhi-Hai
ZH
Mao
Feng
F
Dong
Jun-Jun
JJ
Ma
Min-Hua
MH
Zheng
D002681:China; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D018709:Statistics, Nonparametric; D016019:Survival Analysis