Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

• Published in: Vascular health and risk management Vol. 13; pp. 217 - 224
• Main Authors: Krog, Anne Helene, Sahba, Mehdi, Pettersen, Erik M, Wisløff, Torbjørn, Sundhagen, Jon O, Kazmi, Syed Sh
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2017; Taylor & Francis Ltd; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Abdomen; Aged; Aortic Diseases - economics; Aortic Diseases - surgery; aortobifemoral bypass; Area Under Curve; Blood Vessel Prosthesis - economics; Blood Vessel Prosthesis Implantation - economics; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Cancer; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical trials; Comparative analysis; Coronary artery bypass; Cost analysis; Cost benefit analysis; cost-utility; Diagnosis related groups; DRGs; EQ-5D; Female; Femoral Artery - surgery; Generalized linear models; Health aspects; Health care expenditures; Health services; health-related quality of life (HRQoL); Heart surgery; Hospital Costs; Humans; Ischemia; Laparoscopy; Laparoscopy - economics; Laparoscopy - instrumentation; Length of Stay - economics; Male; Middle Aged; Models, Economic; Norway; Original Research; Pain; Patients; Peripheral Arterial Disease - economics; Peripheral Arterial Disease - surgery; Process Assessment (Health Care) - economics; Prospective Studies; quality adjusted life years (QALY); Quality of life; Quality-Adjusted Life Years; Questionnaires; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vascular surgery; Norway; laparoscopy; quality-adjusted life years; EQ-5D; cost-effectiveness; QALYs; aortobifemoral bypass; HRQoL; health-related quality of life; cost-utility
• ISSN: 1178-2048; 1176-6344; 1178-2048
• DOI: 10.2147/VHRM.S138516

Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients' health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass. This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay. We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, ( =0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), ( =0.001). Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.