Economic evaluation of laparoscopic surgery for colorectal cancer

Abstract

Objectives: To assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer. Methods: A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life year gained and using cost-effectiveness acceptability curves (CEACs) to illustrate the likelihood that a treatment was cost-effective at various threshold values for society’s willingness to pay for an additional life year. Results: Laparoscopic surgery was on average £300 more costly and slightly less effective than open surgery and had a 30% chance of being cost-effective if society is willing to pay £30,000 for a life year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality adjusted life year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits following laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective. Conclusions: Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes and an additional £300 per patient. A judgement is required as to whether the short-term benefits are worth this extra cost.