Cost-eﬀectiveness analysis of laparoscopic versus open surgery
in colon cancer
· Ane Anton‑Ladislao
· Oliver Ibarrondo
· Arantzazu Arrospide
· Santiago Lázaro
· Marisa Bare
· Daniel Callejo
· Maximino Redondo
· José M. Quintana
on behalf of the
Received: 21 November 2017 / Accepted: 29 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Few economic evaluations have assessed laparoscopy for colon cancer. This study aimed to compare the cost-
eﬀectiveness of laparoscopic and open surgery for the treatment of colon cancer.
Method A cost-eﬀectiveness analysis was performed comparing two groups of patients treated according to standard clini-
cal practice (REDISSEC-CARESS/CCR cohort) by laparoscopic or open surgery. Data were collected from health records
on clinical characteristics and resource use over 2 years after surgery. To calculate the incremental cost-eﬀectiveness ratio,
costs and quality-adjusted life years (QALYs) were obtained for each patient. Clinical heterogeneity was addressed using
propensity score and joint multivariable analysis (seemingly unrelated regression) that included interactions between TNM
stage, age, and surgical procedure to perform subgroup analysis.
Results The sample was composed of 1591 patients, 963 who underwent laparoscopy and 628 open surgery. Using propensity
score and regression analysis, we found that laparoscopy was associated with more QALYs and less resource use than open
surgery (0.0163 QALYs, 95% CI 0.0114–0.0212; and − €3461, 95% CI − 3337 to − 3586). Costs were lower for laparoscopy
in all subgroups. In the subgroups younger than 80 years old, utility was higher in patients who underwent laparoscopy.
Nevertheless, open surgery had better outcomes in older patients in stages I–II (0.0618 QALYs) and IV (0.5090 QALYs).
Conclusion Overall, laparoscopy appears to be dominant, resulting in more QALYs and lower costs. Nevertheless, while
laparoscopy required fewer resources in all subgroups, outcomes may be negatively aﬀected in elderly patients, representing
an opportunity for shared decision making between surgeons and patients.
ClinicalTrials.gov Identiﬁer: NCT02488161
Keywords Colon cancer · Laparoscopy · Open surgery · Cost-eﬀectiveness
Given the high incidence of colon cancer (CC), the choice of
the procedure for surgical treatment is important not only for
patients and surgeons but also for policy makers [1, 2]. As in
any other health technology assessment, a topic under dis-
cussion in CC management is the eﬃciency of laparoscopic
resection compared to open resection [3, 4]. The literature
indicates that a laparoscopic approach generally shortens
the length of hospital stay [5–8], but also that it lengthens
operating times and therefore surgical costs [4, 9]. Although
the cost-eﬀectiveness of new pharmacological treatments for
cancer is well documented [10, 11], there seems to be less
interest in generating evidence concerning the diﬀerent sur-
gical approaches applied to CC treatment . In addition,
economic evaluations of surgical procedures are not usually
conducted using recommended methodologies . Further,
Murray et al. have underlined the limited nature of the data
available on both costs and utilities . Therefore, there is
an urgent need to carry out studies to measure the eﬃciency
of surgical procedures, in general, and laparoscopic surgery
in CC treatment, in particular.
and Other Interventional Techniques
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0046 4-018-6250-9) contains
supplementary material, which is available to authorized users.
The members of the REDISSEC_CARESS/CCR group are listed
in Acknowledgment section.
* Javier Mar
Extended author information available on the last page of the article