Laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma: cost-effectiveness analysis

Abstract

Background: Laparoscopic subtotal gastrectomy (LSG) for cancer is associated with good perioperative outcomes and superior quality of life compared with the open approach, albeit at higher cost. An economic evaluation was conducted to compare the two approaches. Methods: A cost-effectiveness analysis between LSG and open subtotal gastrectomy (OSG) for gastric cancer was performed using a decision-tree cohort model with a healthcare system perspective and a 12-month time horizon. Model inputs were informed by a meta-analysis of relevant literature, with costs represented in 2016 Canadian dollars (CAD) and outcomes measured in quality-adjusted life-years (QALYs). A secondary analysis was conducted using inputs extracted solely from European and North American studies. Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results: In the base-case model, costs of LSG were $935 (€565) greater than those of OSG, with an incremental gain of 0⋅050 QALYs, resulting in an incremental cost-effectiveness ratio of $18 846 (€11 398) per additional QALY gained from LSG. In the DSA, results were most sensitive to changes in postoperative utility, operating theatre and equipment costs, as well as duration of surgery and hospital stay. PSA showed that the likelihood of LSG being cost-effective at willingness-to-pay thresholds of $50 000 (€30 240) per QALY and $100 000 (€60 480) per QALY was 64 and 68 per cent respectively. Secondary analysis using European and North American clinical inputs resulted in LSG being dominant (cheaper and more effective) over OSG, largely due to reduced length of stay after LSG. Conclusion: In this decision analysis model, LSG was cost-effective compared with OSG for gastric cancer.

Cost-effectiveness of Laparoscopic vs Open Gastrectomy for Gastric Cancer

“…Recently, a model-based cost-effectiveness study reported laparoscopic distal gastrectomy to be cost-effective compared with open distal gastrectomy . Cost-effectiveness was contrived by combining costs from a retrospective Canadian data set, QALYs from 2 clinical studies performed between 2000 and 2005, and complication probabilities from eastern randomized clinical trials and western retrospective studies on laparoscopic vs open distal gastrectomy . Hence, it is likely more representative for early gastric cancer in the eastern population than for advanced cancer or the western population .…”

“…To date, the costs and cost-effectiveness of laparoscopic gastrectomy have been analyzed in 3 observational cohort studies . Furthermore, a model-based study was recently performed, using input from eastern randomized clinical trials and western retrospective studies on laparoscopic distal gastrectomy only . Hence, it remains difficult to draw conclusions on the costs and cost-effectiveness of laparoscopic total and distal gastrectomy, especially for the western population …”

Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy

“…Meanwhile, an interesting phenomenon was found that LTG cost more on operation and less on total hospitalization than OTG, which was similar to the results of the studies by Tegels et al [ 27 ] and Hoya et al [ 28 ]. Gosselin-Tardif et al [ 29 ] also found that the application of laparoscopic gastrectomy was more cost-effective compared with open gastrectomy in Canadians. We reckon that the fact that expensive disposable surgical instruments mostly relied on import might elevate surgical cost in LTG, but fast postoperative recovery could offset deviations by reducing other costs, which suggested LTG as a probable cost-effective alternative surgical approach after NACT.…”

The Comparison of the Short and Long-Term Outcomes Between Laparoscopic Total Gastrectomy and Open Total Gastrectomy for Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy

“…Meanwhile, we found an interesting phenomenon that LTG cost more on operation and cost less on total hospitalization compared with OTG, which was similar to Tegels JJ [22] and Hoya Y's [23] study. Gosselin-Tardif A [24] also presented Canadian perspective that the application to laparoscopic gastrectomy was cost-effective compared with open gastrectomy. We reckoned that even expensive disposable surgical instruments mostly rely on import might elevate surgical cost in LTG, faster postoperative recovery could offset deviations by reducing other costs, which predicted LTG as a probable cost-effective alternative surgical approach after NACT.…”