Cost comparison of laparoscopic colectomy versus open colectomy in colon cancer

Abstract

Background: Laparoscopic colectomy has been shown to be safe, oncologically comparable, and clinically beneficial over open colectomy for colon cancer, but utilization remains low.

Objectives To evaluate the cost of laparoscopic colectomy vs open colectomy for colon cancer.

Methods: The authors conducted a retrospective claims data analysis using the 2012 and 2013 Truven Health Analytics MarketScan Commercial Claims and Encounter Database. The denominator population consisted of individuals who had commercial insurance coverage in all months of 2012 and >1 month in 2013 and pharmacy coverage throughout eligibility. The study population included individuals aged 18–64 years who were identified with colon cancer in 2013 and underwent an elective inpatient open colectomy or laparoscopic colectomy between January and November 2013. The cost and re-admission rate of open vs laparoscopic colectomy were compared after risk, adjusting for comorbidities, demographics, and geographic region.

Results: During the study period, 1299 elective inpatient colon cancer colectomies were performed (open, n = 558; laparoscopic, n = 741). After risk adjustment, the laparoscopic vs open group was shown to have lower re-admission rates (6.61 and 10.93 per 100 cases, respectively, p = .0165), lower average re-admission costs ($1676 and $3151, respectively, p = .0309), and lower 30-day post-discharge healthcare utilization costs ($4842 and $7121, respectively, p = .0047). Average allowed cost for the combined inpatient and 30-day post-discharge period was lower for laparoscopic vs open colectomy cases ($36,395 and $44,226, respectively, p < .001).

Conclusions: The cost of laparoscopic colectomy was found to be statistically significantly less than that of open colectomy in patients undergoing elective surgery for colon cancer.

Keywords:

• Colon cancer
• healthcare outcomes
• laparoscopic colectomy
• open colectomy

Transparency

Declaration of funding

Work done by Milliman was funded by the Medtronic Minimally Invasive Surgical Therapies Group.

Declaration of financial/other relationships

The authors declare no financial/other relationships. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.