OBJECTIVES: Laparoscopic surgery is a well-established treatment option for malignant colorectal disease. Despite the demonstrated clinical advantages, its adoption is very low in Italy (around 36%) and highly variable across the regions. The objective of this study was to assess direct economic impact of using laparoscopic procedures compared with open procedures in colorectal cancer surgery.

METHODS: A budget impact model was developed from a hospital perspective. Inpatient costs included devices, operating room (OR), hospital stay (LOS) and treatment costs for major complications. Major complications included anastomotic leak, surgical site infection (SSI) and bleeding. Peer-reviewed literature was leveraged to inform procedural costs for hourly OR cost, daily cost of LOS, frequencies of major complications, incremental costs of complications and conversion from laparoscopy to open (5%). Quantities of the devices used were based on literature as well as expert opinion, while unit costs of devices were based on average selling price in 2018 EUR. The cost estimate for converted cases was reported under laparoscopic surgery.

RESULTS: Per procedure, an estimated potential cost saving from open to laparoscopic surgery was €1,454. Open surgery incurred lower device and OR costs, laparoscopic surgery demonstrated cost saving on hospital stay and treatment for complications, fully offsetting the upfront device costs of laparoscopic approach. Operating times were marginally increased with laparoscopic surgery (3.4 hours vs. 3.3 (open)); however, LOS was reduced from 13.2 days (open) to 9.5 days (laparoscopic). Laparoscopic surgery was associated with reduction of major complication rates per surgery (cost saving): 8.5% to 4.6% less anastomotic leaks (€165), 13.5% to 6.2% (€365) less SSI, and 3.5% to 1.5% (€46) less bleeding.

CONCLUSIONS: In colorectal cancer surgery, adoption of the laparoscopic approach can help reduce overall hospital cost in addition to inherent clinical and patient benefits as recognized by the Italian Society of Colorectal Surgery guidelines.