Minimally invasive pancreatic resections: cost and value perspectives

Conlon, Kevin C.; Rooij, Thijs de; Hilst, Jony van; Hidal, Mohammad Abu; Fleshman, Julie; Talamonti, Mark S.; Vanounou, Tsafrir; Garfinkle, Richard; Velanovich, Vic; Kooby, David A.; Vollmer, Charles M.; Asbun, Horacio J.; Barkun, Jeffrey; Besselink, Marc G.; Boggi, Ugo; Han, Ho‐Seong; Hansen, Paul; Kendrick, Michael L.; Montagnini, André L.; Palanivelu, Chinnusamy; Røsok, Bård I.; Shrikhande, Shailesh V.; Wakabayashi, Go; Zeh, Herbert J.

doi:10.1016/j.hpb.2017.01.019

Cited by 33 publications

(20 citation statements)

References 41 publications

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“…In a recent metaanalysis, MIPD was associated with increased lymph node retrieval and higher R0 resection rates. 37 Another potential advantage of MIPD may be in the receipt of adjuvant chemotherapy. OPD has been reported to be associated with nearly half the patients never recovering sufficiently to receive adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive pancreatoduodenectomy

Kendrick

Hilst

Boggi

et al. 2017

HPB

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Section: Discussionmentioning

confidence: 99%

“…Training, research and cost were specifically addressed in a dedicated session and are reported elsewhere in this issue. [35][36][37]…”

Section: Conversionsmentioning

confidence: 99%

Minimally invasive pancreatoduodenectomy

Kendrick

Hilst

Boggi

et al. 2017

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“…Data on the costs of minimally invasive distal pancreatectomy are limited. One systematic review combined data from 12 small retrospective studies, and showed that intraoperative costs were higher for minimally invasive distal pancreatectomy. In eight of these studies, the higher costs were compensated for by lower postoperative costs.…”

Section: Introductionmentioning

confidence: 99%

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

Hilst¹,

Strating²,

Rooij³

et al. 2019

British Journal of Surgery

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Background Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost‐effectiveness and impact on disease‐specific quality of life have yet to be established. Methods The LEOPARD trial randomized patients to minimally invasive (robot‐assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease‐specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost‐effectiveness and cost–utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality‐adjusted life‐year. Results All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot‐assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference €–427 (95 per cent bias‐corrected and accelerated confidence interval €–4700 to 3613; P = 0·839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0·566 of being more cost‐effective than the open approach at a willingness‐to‐pay threshold of €0 per day of earlier recovery, and a probability of 0·676 per additional quality‐adjusted life‐year at a willingness‐to‐pay threshold of €80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i.q.r. 5·75–10) versus 7 (4–8·75); P = 0·056) and disease‐specific quality of life after minimally invasive (laparoscopic and robot‐assisted procedures) versus open distal pancreatectomy. Conclusion Laparoscopic distal pancreatectomy was at least as cost‐effective as open distal pancreatectomy in terms of time to functional recovery and quality‐adjusted life‐years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

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“…Since its beginnings during the 1990s, the development of minimally invasive distal pancreatectomy has been constant and progressive, and the number of surgeons across multiple countries adopting this approach has grown rapidly, especially in the last decade . Its feasibility and safety as well as its improved benefits over the traditional open approach have been investigated . In this last decade, however, the discussion has been dominated by the comparison of LDP to RDP, especially regarding costs that, up to now, have been poorly reported .…”

Section: Discussionmentioning

confidence: 99%

“…22 Its feasibility and safety as well as its improved benefits over the traditional open approach have been investigated. [3][4][5][6]22,23 In this last decade, however, the discussion has been dominated by the comparison of LDP to RDP, especially regarding costs that, up to now, have been poorly reported. [24][25][26] There is, therefore, an increasing demand from both patients and surgeons of these approaches to investigate the balance of the costs and benefits of We did not find any significant difference with regard to blood loss and main postoperative outcomes, except for the mean length of hospital stay, which was much higher in LDP.…”

Section: Discussionmentioning

confidence: 99%

A cost‐effectiveness analysis of robotic versus laparoscopic distal pancreatectomy

Vicente

Alfonsel

Ielpo

et al. 2020

Robotics Computer Surgery

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Aim There is no study in the literature that evaluates the cost‐effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP). We performed a comparative study of RDP and LDP with the aim of evaluating clinical and cost‐effective outcomes. Material and Methods This is an observational, comparative prospective nonrandomized study. The primary end point was to compare the cost‐effectiveness differences between both groups. A willingness to pay of €20 000 and €30 000 per quality‐adjusted life year (QALY) was used as a threshold to recognize which treatment was most cost‐effective. Results A total of 31 RDP and 28 LDP have been included. The overall mean total cost was similar in both groups (RDP: €9712.15 versus LDP: €9424.68; P > .5). Mean QALYs for RDP (0.652) was higher than that associated with LDP (0.59) (P > .5). Conclusion This study seems to provide data of cost‐effectiveness between RDP and LDP approaches, showing some benefits for RDP.

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Minimally invasive pancreatic resections: cost and value perspectives

Cited by 33 publications

References 41 publications

Minimally invasive pancreatoduodenectomy

Minimally invasive pancreatoduodenectomy

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

A cost‐effectiveness analysis of robotic versus laparoscopic distal pancreatectomy

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