Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer

Abstract

BackgroundA recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer.MethodModel based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken.ResultsThe probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive (£3,708.58 (95% confidence intervals (CI) -£9,473.62 to £16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy. The probability laparoscopic distal pancreatectomy was cost-effective compared to open distal pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England (£20,000 to £30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time.ConclusionsThere is considerable uncertainty about whether laparoscopic distal pancreatectomy is cost-effective compared to open distal pancreatectomy for pancreatic cancer in the NHS setting.

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

“…The findings of the present study are largely in line with the available data on costs and cost‐effectiveness in laparoscopic versus open distal pancreatectomy, but also in other types of laparoscopic surgery. To be able to interpret the cost‐effectiveness probabilities, more information regarding the societal willingness‐to‐pay threshold for earlier recovery is needed.…”

“…In this study, the probabilities of complications were derived from the literature and expert opinion. Gurusamy and co‐workers reported a probability of 0·70–0·80 that laparoscopic distal pancreatectomy was cost‐effective (willingness‐to‐pay threshold €23 163–34 744; £20 000–30 000, exchange rate 10 March 2019); however, this analysis included only patients with pancreatic cancer, whereas a large proportion of patients undergoing distal pancreatectomy have other conditions such as pancreatic cysts.…”

A cost‐effectiveness analysis of robotic versus laparoscopic distal pancreatectomy

“…However, the simplistic overall cost of an operation can only give limited information about the benefits of a new technique. Only a cost‐effectiveness analysis can help to understand the real difference between two operations, and in the current literature, only one study from Gurusamy et al, which compares open vs LDP, includes data of this type …”

Encuesta nacional sobre las Unidades de Cirugía Pancreática

“…La cirugía pancreá tica laparoscó pica ha tardado en difundirse dentro de las Unidades de Cirugía Pancreá tica, especialmente la DPC ya que es té cnicamente muy demandante 15,16 . En una encuesta mundial sobre cirugía pancreá tica laparoscó pica realizada entre cirujanos pancreá ticos, el 79% de ellos realizaban PD laparoscó pica y un 29% DPC laparoscópica.…”