Year: 2018
Type: dissertation
Abstract: The aim of this thesis was to compare minimally invasive- with traditional open\nsurgical techniques for various diseases with regards to cost-effectiveness. Health\neconomic evaluations were performed using data from clinical trials and routine care\ndata from registers. The healthcare perspective was represented in all four studies and\nthe societal perspective (including sick-leave costs) was represented in three out of\nfour studies.\nPaper I included a cost-minimization analysis of laparoscopic and open surgery as\ntreatment for rectal cancer within the randomized, controlled COLOR II trial. From\nthe healthcare perspective laparoscopic surgery was costlier while from the societal\nperspective no significant long-term difference was observed. Paper II included a cost\nanalysis of laparoscopic lavage versus Hartmann’s procedure as treatment for\ncomplicated diverticulitis with purulent peritonitis within the randomized, controlled\nDILALA trial. Laparoscopic lavage was considered less costly both at 12 months and\nthroughout patients’ expected life, from the healthcare perspective. Paper III was a cost\nanalysis of robot-assisted laparoscopic prostatectomy (RALP) versus open surgery for\nprostate cancer within the prospective trial LAPPRO. RALP was associated with a\nhigher mean cost than open surgery from both the healthcare and societal perspective\nat 24 months. Paper IV was a prospective cohort study of cost-effectiveness for\nlaparoscopic versus open surgery as treatment for colorectal cancer, with resource use\ndata and unit costs derived from Swedish national registers. Laparoscopic surgery was\nassociated with better clinical and cost outcomes from both healthcare and societal\nperspectives at 12 months after primary surgery.\nMinimally invasive surgery can be cost saving compared to conventional open surgery.\nIt is advisable to perform economic evaluations in routine care, as cost-effectiveness\nof surgical techniques most likely will change over time.
Author: Jacob Gehrman
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2800168156