Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery.
OBJECTIVES
Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients' health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass.


PATIENTS AND METHODS
This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay.


RESULTS
We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), (p=0.001).


CONCLUSION
Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.
['Krog|Anne Helene|AH|', 'Sahba|Mehdi|M|', 'Pettersen|Erik M|EM|', 'Wisløff|Torbjørn|T|', 'Sundhagen|Jon O|JO|', 'Kazmi|Syed Sh|SS|']
D000368:Aged D001018:Aortic Diseases D019540:Area Under Curve D001807:Blood Vessel Prosthesis D019917:Blood Vessel Prosthesis Implantation D003362:Cost-Benefit Analysis D005260:Female D005263:Femoral Artery D017721:Hospital Costs D006801:Humans D010535:Laparoscopy D007902:Length of Stay D008297:Male D008875:Middle Aged D018803:Models, Economic D009664:Norway D058729:Peripheral Arterial Disease D017064:Process Assessment, Health Care D011446:Prospective Studies D019057:Quality-Adjusted Life Years D011795:Surveys and Questionnaires D013997:Time Factors D016896:Treatment Outcome
cost-utility aortobifemoral bypass health-related quality of life quality-adjusted life years QALYs cost-effectiveness EQ-5D HRQoL laparoscopy