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Cost-effectiveness of laparoscopic versus open pyloromyotomy

Cost-effectiveness of laparoscopic versus open pyloromyotomy
Cost-effectiveness of laparoscopic versus open pyloromyotomy
Background: infantile hypertrophic pyloric stenosis can be corrected by either open (OP) or laparoscopic pyloromyotomy (LP). LP may provide clinical benefits of reduced time to postoperative full feeds and reduced postoperative inpatient stay, but the cost effectiveness is not known. Our aim was to compare the cost effectiveness of laparoscopic and open pyloromyotomy.

Methods: OP and LP were compared in a multicenter randomized double-blind controlled trial, for which the primary outcomes were time to full feeds and time to discharge. In order to undertake a detailed cost analysis, we assigned costs, calculated on an individual patient basis, to laboratory costs, imaging, medical staff, medication, ward, operative, and outpatient appointments for 74 patients recruited from one of the participating centers. Data (mean ± SEM) were compared using linear regression analysis, adjusting for the minimization criteria used in the trial.

Results: operation costs were similar between the two groups ($3,276 ± $244 LP versus $3,535 ± $152 OP). A shorter time to full feeds and shorter hospital stay in LP versus OP patients resulted in a highly significant difference in ward costs ($2,650 ± $126 LP versus $3,398 ± $126 OP; P = .001) and a small difference in other costs. Overall, LP patients were $1,263 (95% confidence interval $395–$2,130; P = .005) less expensive to treat than OP patients. Sensitivity analyses of laparoscopic hardware usage and of incomplete pyloromyotomy indicated that LP was consistently less expensive than OP.

Conclusions: LP is a cost-effective alternative to OP as it delivers improved clinical outcome at a lower price
0022-4804
315-320
Carrington, Emma V.
9c0465da-61eb-4669-addb-8ce5bf67b9cf
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Pacilli, Maurizio
f48aaca5-a083-422b-9784-aacdbe4be5dd
Drake, David P.
1d035b50-5ccd-46a5-93b8-75c120310293
Curry, Joseph I.
fb4a4769-5ee8-4ed2-8fee-e1d1599b528c
Kiely, Edward M.
40af8c7d-a7f7-4017-bc6e-39f53ee90508
De Coppi, Paolo
b4236c8b-8700-4797-a529-d8791b59088b
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283
Carrington, Emma V.
9c0465da-61eb-4669-addb-8ce5bf67b9cf
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Pacilli, Maurizio
f48aaca5-a083-422b-9784-aacdbe4be5dd
Drake, David P.
1d035b50-5ccd-46a5-93b8-75c120310293
Curry, Joseph I.
fb4a4769-5ee8-4ed2-8fee-e1d1599b528c
Kiely, Edward M.
40af8c7d-a7f7-4017-bc6e-39f53ee90508
De Coppi, Paolo
b4236c8b-8700-4797-a529-d8791b59088b
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283

Carrington, Emma V., Hall, Nigel J., Pacilli, Maurizio, Drake, David P., Curry, Joseph I., Kiely, Edward M., De Coppi, Paolo, Pierro, Agostino and Eaton, Simon (2012) Cost-effectiveness of laparoscopic versus open pyloromyotomy. The Journal of Surgical Research, 178 (1), 315-320. (doi:10.1016/j.jss.2012.01.031). (PMID:22480835)

Record type: Article

Abstract

Background: infantile hypertrophic pyloric stenosis can be corrected by either open (OP) or laparoscopic pyloromyotomy (LP). LP may provide clinical benefits of reduced time to postoperative full feeds and reduced postoperative inpatient stay, but the cost effectiveness is not known. Our aim was to compare the cost effectiveness of laparoscopic and open pyloromyotomy.

Methods: OP and LP were compared in a multicenter randomized double-blind controlled trial, for which the primary outcomes were time to full feeds and time to discharge. In order to undertake a detailed cost analysis, we assigned costs, calculated on an individual patient basis, to laboratory costs, imaging, medical staff, medication, ward, operative, and outpatient appointments for 74 patients recruited from one of the participating centers. Data (mean ± SEM) were compared using linear regression analysis, adjusting for the minimization criteria used in the trial.

Results: operation costs were similar between the two groups ($3,276 ± $244 LP versus $3,535 ± $152 OP). A shorter time to full feeds and shorter hospital stay in LP versus OP patients resulted in a highly significant difference in ward costs ($2,650 ± $126 LP versus $3,398 ± $126 OP; P = .001) and a small difference in other costs. Overall, LP patients were $1,263 (95% confidence interval $395–$2,130; P = .005) less expensive to treat than OP patients. Sensitivity analyses of laparoscopic hardware usage and of incomplete pyloromyotomy indicated that LP was consistently less expensive than OP.

Conclusions: LP is a cost-effective alternative to OP as it delivers improved clinical outcome at a lower price

Full text not available from this repository.

More information

Accepted/In Press date: 18 January 2012
Published date: November 2012
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 378455
URI: https://eprints.soton.ac.uk/id/eprint/378455
ISSN: 0022-4804
PURE UUID: d437e9b0-3c72-4300-b9b5-54c024e684d7
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 03 Jul 2015 10:52
Last modified: 06 Jun 2018 12:31

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Contributors

Author: Emma V. Carrington
Author: Nigel J. Hall ORCID iD
Author: Maurizio Pacilli
Author: David P. Drake
Author: Joseph I. Curry
Author: Edward M. Kiely
Author: Paolo De Coppi
Author: Agostino Pierro
Author: Simon Eaton

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