Analysis of the Cost Effectiveness of Laparoscopic Pancreatoduodenectomy

Abstract

OBJECTIVE We sought to determine if laparoscopic pancreatoduodenectomy (LPD) is a cost effective alternative to open pancreatoduodenectomy (OPD). METHODS Hospital cost data, discharge disposition, readmission rates, and readmission costs from periampullary cancer patient cohorts of LPD and OPD were compared. The surgical cohorts over a 40 month period were clinically similar, consisting of 52 and 50 patients in the LPD and OPD groups, respectively. RESULTS The total operating room costs were higher in the LPD group as compared to the OPD group (median: $12,290 vs $11,299; P = 0.05) due to increased costs for laparoscopic equipment and regional nerve blocks (P ≤ 0.0001). Although hospital length of stay was shorter in the LPD group (median: 7 vs 8 days; P = 0.025), the average hospital cost was not significantly decreased compared to the OPD group (median: $28,496 vs $28,623). Surgery-related readmission rates and associated costs did not differ between groups. Compared to OPD patients, significantly more LPD patients were discharged directly home rather than to other healthcare facilities (88% vs 72%; P = 0.047). CONCLUSION For the index hospitalization, the cost of LPD is equivalent to OPD. Total episode-of-care costs may favor LPD via reduced post-hospital needs for skilled nursing and rehabilitation.

Cost‐effectiveness of minimally invasive pancreatic resection

“…Anesthesia and operating room costs were significantly higher for LPD compared to OPD in one study, but similar in a recently published study by Gerber et al. . Only Tan et al.…”

“…They are shown in Table . Operative costs were significantly higher for LPD compared to OPD in all four studies that reported on this topic (overall, +$1,372) due to higher costs for surgical equipment . Anesthesia and operating room costs were significantly higher for LPD compared to OPD in one study, but similar in a recently published study by Gerber et al.…”

“…Overall, costs for the total hospital stay were slightly decreased in the LPD group compared to OPD (−$1,268). Cost associated with readmission were lower for the LDP group (−$919) .…”

“…There was a trend towards lower cost for post‐anesthesia care unit (−$2,293), laboratory tests (−$670), medication/pharmacy (−$367) and imaging/radiology (−$191) for the laparoscopic group . Cost for the total hospital stay were reported to be similar in four studies and significantly higher for LPD compared to OPD by one study . Overall, costs for the total hospital stay were slightly decreased in the LPD group compared to OPD (−$1,268).…”

“…While higher operative cost associated with the laparoscopic approach for both, DP and PD were observed due to higher equipment cost and operating room expenses, the main contributor to reduced postoperative costs for MIPR was the shorter length of stay, which was reported to be significantly reduced for MIPR compared to OPR in 10 of the included studies . Due to comparable complications between MIPR and OPR the shorter hospital stay may be related to an earlier recovery with less postoperative pain and fewer wound infections .…”