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Session: Cost-Effectiveness of Treatment
Room: Helsinki Hall
Time: Thu 16:00-17:15

Presenter: Laura Haas (Helmholtz Zentrum Munich. Institute of Health Economics and Health Care Management)

Abstract

Objective: Many studies have compared outcomes of laparoscopic vs. open appendectomy (LA vs. OA), but a consensus regarding the relative advantages of one technique has not yet been reached. On the one hand, OA is seen as a treatment method with low hospitalization costs and a proven therapeutic efficacy with low morbidity and mortality rates. On the other hand, LA provides some medical advantage over OA, principally through a quicker recovery, less wound infections and postoperative pain.
Methods: The objective of this study was to compare postoperative complications and cost of treatment of LA versus OA and to identify the most cost-effective treatment method. Patients with a diagnosis of appendicitis that were treated with appendectomy in a Veterans Health Administration (VHA) hospital on continental US in 2005 were included into our study. Direct medical cost and postoperative complications during the hospital stay were used as outcomes. We used propensity score matching to adjust for baseline imbalances between both treatment groups. We controlled for severity of appendicitis, co-morbidities selected according to the Charlson Comorbidity Index modified by Deyo, and demographic variables. 1:1 optimal matching with replacement was performed. Based on the matched samples, we estimated regression models for costs and postoperative complications. Besides patients’ covariates, predictors of hospital resource use and quality of care (number of nurses per bed, administrative staff per bed, number of beds, teaching status, and geographic location) were considered as explanatory variables which required the use of generalized linear mixed models including. For costs, we assumed a gamma distribution and used a log-link function. For postoperative complications, a mixed logit model was estimated.
Results: The total study population comprised of 1,128 patients (370 LA, 758 OA) from 95 VHA hospitals. For 346 patients in the LA group, a patient from the OA group could be matched. Results from regression models indicate that type of appendectomy treatment had a significant influence on total costs (p=0.005), while differences in postoperative complications were not significant between LA and OA (p=0.6311). Severity of appendicitis, i.e. peritonitis and peritoneal abscess had a significant impact on costs and post-operative complications. The predicted costs for the average patient undergoing LA amounted to $8995 [95%CI: $8073; $10022], while being 18.3% higher for OA ($10851 [95%CI: $9707; $12131]). The predicted overall postoperative complication rate was 0.85% lower for LA compared to OA. Sensitivity analysis did not change the results.
Conclusions: As predicted costs for LA were $1856 lower than for OA while postoperative complication rate did not differ significantly, LA clearly dominates OA. From the payer’s perspective, LA is therefore the treatment of choice. In addition, when taking into account shorter lengths of stay, faster return to work and better cosmetic results, LA also seems to be the treatment of choice from the patient’s perspective.

Key Terms

cost-effectiveness, laparoscopic appendectomy, Veteran Health Administration, administrative data

Authors:

Laura Haas (Helmholtz Zentrum Munich. Institute of Health Economics and Health Care Management) , Tom Stargardt (Helmholtz Zentrum Munich. Institute of Health Economics and Health Care Management) and Jonas Schreyoegg (Munich School of Management, Munich University. Departement of Health Services Management)

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