title: Health economic analysis of laparoscopic lavage versus Hartmann's procedure for diverticulitis in the randomized DILALA trial.
abstract: BACKGROUND
  Open surgery with resection and colostomy (Hartmann's procedure) has been the standard treatment for perforated diverticulitis with purulent peritonitis. In recent years laparoscopic lavage has emerged as an alternative, with potential benefits for patients with purulent peritonitis, Hinchey grade III. The aim of this study was to compare laparoscopic lavage and Hartmann's procedure with health economic evaluation within the framework of the DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) trial.
  
  
  METHODS
  Clinical effectiveness and resource use were derived from the DILALA trial and unit costs from Swedish sources. Costs were analysed from the perspective of the healthcare sector. The study period was divided into short-term analysis (base-case A), within 12 months, and long-term analysis (base-case B), from inclusion in the trial throughout the patient's expected life.
  
  
  RESULTS
  The study included 43 patients who underwent laparoscopic lavage and 40 who had Hartmann's procedure in Denmark and Sweden during 2010-2014. In base-case A, the difference in mean cost per patient between laparoscopic lavage and Hartmann's procedure was €-8983 (95 per cent c.i. -16 232 to -1735). The mean(s.d.) costs per patient in base-case B were €25 703(27 544) and €45 498(38 928) for laparoscopic lavage and Hartmann's procedure respectively, resulting in a difference of €-19 794 (95 per cent c.i. -34 657 to -4931). The results were robust as demonstrated in sensitivity analyses.
  
  
  CONCLUSIONS
  The significant cost reduction in this study, together with results of safety and efficacy from RCTs, support the routine use of laparoscopic lavage as treatment for complicated diverticulitis with purulent peritonitis.
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Gothenburg University, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, and, Gothenburg, Sweden. jacob.gehrman@gu.se.
authors.forename: J
authors.initials: J
authors.lastname: Gehrman
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Gothenburg University, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, and, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Angenete
authors.affiliation: Nordic Health Economics AB, Gothenburg, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Björholt
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Gothenburg University, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, and, Gothenburg, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Bock
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Gothenburg University, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, and, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Haglind
mesh_terms: D000208:Acute Disease; D000368:Aged; D003125:Colostomy / Q000191:economics; D003365:Costs and Cost Analysis; D004239:Diverticulitis, Colonic / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000191:economics / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000191:economics; D007507:Therapeutic Irrigation / Q000191:economics*; D016896:Treatment Outcome