S. Rey1, A. Ruiz Patino1, G. Molina1, S. Rugeles1 1Hospital Universitario San Ignacio,Department Of Surgery,Bogota, DC, Colombia
Introduction: Colombia is a developing nation in need for efficient resource administration in fields such as healthcare, were innovation is constant. Since the introduction of laparoscopic appendectomy, direct costs have been increasing without definitive results in terms of clinical outcomes. The objective of this study is to determine the cost effectiveness of open vs laparoscopic appendectomy and thereby help surgeons in clinical decision making in a limited resource setting.
Methods: A retrospective cost effectiveness analysis comparing open (OA) vs multiport laparoscopic appendectomy (LA) during 2013 in a third level university hospital (Hospital Universitario San Ignacio) in Bogota, Colombia was performed. Effectiveness was determined as the number of days in additional length of stay due to complications saved. 377 clinical stories were collected by the authors and analyzed for the variables: surgery type, conversion to open laparotomy, complications (surgical site infection, reintervention, re admission), hospital length of stay (LOS) and total cost of hospitalization for initial surgery and subsequent complications related hospitalizations. The total accumulative costs and lengths of stay for OA and LA plus complications were estimated. The cost effectiveness threshold was set at US 46 (139,000 COP), the cost of an additional day in length of stay. An Incremental cost effectiveness ratio (ICER) was calculated for OA as the comparator and LA as the intervention.
Results: The number of LA was 130 and for OA 247. The two groups were balanced in terms of population characteristics. Complication rate was 13.7 % for OA and 10.4% for LA (p <0.05) and LOS was 2 days for LA and OP (p=0.9). No conversions from LA to OA were recorded. The total costs for complications for OA were US 8,523 (25,569,220 COP) and US 3,385 (10,157,758 COP) for LA. Cumulative costs including cost of surgery and complications and length of stay for OA were US 65,753 (197,259,310 COP) and 297 respectively. For LA were US 66,425 (199,276,948 COP) and 271. The ICER was US 25.86 (77,601 COP) making LA a cost effective alternative with a difference of US 20.76 (62,299 COP) under the Cost-effectiveness threshold.
Conclusion: Laparoscopic appendectomy is a cost effective alternative over open appendectomy with an increasing cost of $25.85 per day of additional hospitalization due to complications saved. This is accounting the low cost of surgical interventions and complications in developing nations such as Colombia.