A Randomized Trial With a Cost-Consequence Analysis After Laparoscopic and Abdominal Hysterectomy

Ellström, Marie; Ferraz-Nunes, Jose; Hahlin, Mats; Olsson, Jan‐Edvin

doi:10.1016/s0029-7844(97)00579-6

Cited by 104 publications

(53 citation statements)

References 16 publications

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“…The fact that TLH is considered as being preferable, based on the major complication-free rate as the measure of effect, is consistent with a recently published review [5]. In this review, comparing costs and cost effectiveness between laparoscopic and abdominal hysterectomies in twelve prospective controlled trials [14][15][16][17][18][19][20][21][22][23][24][25], laparoscopic hysterectomy pointed in the direction of cost effectiveness due to a lower major complication rate, with higher costs in the laparoscopy group when compared to laparotomy. However, all studies were performed in patients with a benign indication for the removal of the uterus, and used different variants of laparoscopic techniques.…”

Section: Discussionsupporting

confidence: 72%

Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial

Bijen

Vermeulen

Mourits

et al. 2011

Gynecologic Oncology

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Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Objective. To determine the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in early stage endometrial cancer alongside a multicenter randomised controlled trial (RCT).Methods. An economic analysis was conducted in 279 patients (TLH n = 185; TAH n = 94) with early stage endometrial cancer from a societal perspective, including all relevant costs over a three month time horizon. Health outcomes were expressed in terms of major complication-free rate and in terms of utility based on women's response to the EQ-5D. Comparisons of costs per major complication-free patient gained and costs with utility gain and costs were made, using incremental cost effectiveness ratios.Results. The mean major complication-free rate and median utility scores were comparable between TLH and TAH at three months. TLH is more costly intraoperatively (Δ$1.129) and less costly postoperatively inhospital (Δ$−1.350) compared to TAH. Incremental costs per major complication-free patient were $−52. Higher cost ($249) were generated while no gains in utility (−0.02) were observed for TLH compared to TAH. Analysing utility at six weeks, incremental costs per additional point on the EQ-5D scale were $1.617.Conclusion. TLH is cost effective compared to TAH, based on major complication-free rate as measure of effect. Along with future cost saving strategies in laparoscopy, TLH is assumed to be cost effective for both effect measures. Therefore and due to comparable safety, TLH should be recommended as a standard-of-care surgical procedure in early endometrial cancer.

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Section: Discussionsupporting

confidence: 72%

Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial

Bijen

Vermeulen

Mourits

et al. 2011

Gynecologic Oncology

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“…Because differences have been shown at 6 months after surgery, measurement of QoL in future trials should be done at least 6 months. [30] administered the SF-36 to 76 patients (1b). Three weeks after operation, the laparoscopic group had significantly better scores in physical functioning, role-physical, bodily pain, and social functioning.…”

Section: Hysterectomymentioning

confidence: 99%

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

et al. 2004

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Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research. Methods: An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research. Results: Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely.

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“…Sick leave has been used frequently as an outcome for comparing minimally invasive surgery with conventional open surgery. Although the direct costs resulting from disposable instruments and the operating time may be greater with the laparoscopic approach, the profit in terms of productivity costs may be substantial, possibly compensating for the higher direct hospital costs [1,2].However, sick leave is determined not only by the surgical approach, but also by subjective recovery in combination with local and personal factors such as employment, job satisfaction, psychological well-being, and given recommendations (expectations) about work resumption, regardless of the surgical technique. Convalescence recommendations given by medical professionals show substantial variability and are not evidence based [3].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference

et al. 2008

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Background Sick leave frequently has been used as an outcome to evaluate minimal invasive surgery compared with conventional open surgery. However, sick leave is determined not only by the surgical approach. Recently, a postoperative recovery-specific quality-of-life questionnaire, the Recovery Index (RI-10), has been developed and validated. This study investigated the relation of the Recovery Index 10, the RI-6 (a subset of 6 questions), and the type of surgery to sick leave. Methods The study enrolled 46 patients with a paid job scheduled for elective gynecologic surgery, who filled out the RI-10. After 8 weeks, the patients were approached by telephone to give information on their return to work. Results Of the 46 patients, 23 (50%) returned to work completely after 8 weeks, 14 (30%) resumed work partly, and 9 (20%) did not resume work at all. In the analysis, the patients who completely returned to work were compared with those who did not return or partially returned. Recovery as expressed in the RI-6 improved with time after surgery. It appeared that the measurement 2 weeks after surgery showed the best discriminative capacity to predict sick leave after 8 weeks, with an area under the curve of 0.88 (confidence interval, 0.74-1.03). The subjective postoperative recovery as expressed by the RI-6 is more closely related to the type of surgery (p = 0.001) sick leave is (p = 0.14). Conclusions The subjective recovery scored by the patient on a questionnaire of six questions is a better outcome than sick leave for evaluating surgical approaches. If administered 2 weeks after surgery, it may predict prolonged sick leave.Keywords Gynecology Á Laparoscopy Á Postoperative recovery Á Quality of life Á Sick leaveThe main objective of laparoscopic surgery is to reduce postoperative recovery time by making smaller wounds than laparotomy. Consequently, patients can resume their daily activities and work sooner. In this way, the laparoscopic approach may reduce the sick leave of workers and their loss of productivity after surgery. Sick leave has been used frequently as an outcome for comparing minimally invasive surgery with conventional open surgery. Although the direct costs resulting from disposable instruments and the operating time may be greater with the laparoscopic approach, the profit in terms of productivity costs may be substantial, possibly compensating for the higher direct hospital costs [1,2].However, sick leave is determined not only by the surgical approach, but also by subjective recovery in combination with local and personal factors such as employment, job satisfaction, psychological well-being, and given recommendations (expectations) about work resumption, regardless of the surgical technique. Convalescence recommendations given by medical professionals show substantial variability and are not evidence based [3]. Consequently, the advantage of the laparoscopic approach might not be fully realized.

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A Randomized Trial With a Cost-Consequence Analysis After Laparoscopic and Abdominal Hysterectomy

Abstract: A change in surgical technique from abdominal to laparoscopic hysterectomy was possible without compromising the health status of the patients, and it provided substantial financial benefits to society.

Cited by 104 publications

References 16 publications

Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial

Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference

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