Is the National Training Programme for Laparoscopic Colorectal Surgery (LAPCO) Value for Money?

Speaker(s)

Ni M1, Mackenzie H2, Zamora Talaya MB3, Miskovic D4, Wyles S5, Coleman M2, Hanna G6
1Imperial College, London, UK, 2University Hospitals Plymouth, Plymouth, UK, 3Imperial College, London, LON, UK, 4St Mark's hospital, London, CS, UK, 5Kaiser Permanente, San Francisco, CA, USA, 6Imperial College, London, CS, UK

Presentation Documents

OBJECTIVES: The English National Training Program of laparoscopic colorectal surgeries (Lapco) provided mentored training to enable the surgeons (delegates) to achieve competency in laparoscopic colorectal cancer surgeries. Our previous work has demonstrated the clinical effectiveness of mentored training. This research aimed to assess whether mentored training provided by Lapco was cost-effective.

METHODS: We evaluated how Lapco delegates differed from the self-taught surgeons to achieve competency by evaluating the length of learning required and the differences between clinical outcomes. The number of laparoscopic colorectal cancer cases needed in order to reach stable performance, i.e. learning curve, differed across key quality measures of a laparoscopic surgery. These included conversion rates (i.e. converting from keyhole to open surgery), major complication rates and length of hospital stay. We assessed the cumulative differences in these measured throughout the time it took for an average self-taught surgeon to achieve plateau. We assessed the economic impact of the clinical outcomes based on a review of the literature.

RESULTS: Lapco trained a total number of 144 surgeons (delegates) in the UK. Lapco delegates outperformed self-taught surgeons in conversion (5.0% versus 8.75%), complication (14.3% versus 15.93%) and LOS (5 days versus 7 days). We estimated that the costs for treating each complication is £8,662 and the cost for each additional day of hospital stay is £395. We were unable to identify costs for fewer conversions. The savings due to fewer complications in Lapco were worth £1.8 million and the savings due to shorter Length of hospital stay was worth £17 million. The latter alone far exceeded the total costs for Lapco which was estimated at around £6 million.

CONCLUSIONS: Carefully designed and implemented surgical training programmes, though expensive in itself, can be cost-effective due to better patient outcomes as well as a steeper learning curve compared to the self-taught modality of learning.

Code

HSD4

Topic

Clinical Outcomes, Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Performance-based Outcomes

Disease

SDC: Oncology