|
Laparoscopic versus conventional surgery for suspected appendicitis in women |
Zaninotto G, Rossi M, Anselmino M, Costantini M, Pianalto S, Baldan N, Pizzato D, Ancona E |
|
|
Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Laparoscopic surgery for suspected appendicitis in women.
Economic study type Cost-effectiveness analysis.
Study population Female patients admitted to the surgical ward with right lower abdominal pain and a suspected diagnosis of appendicitis.
Setting Hospital. The economic study was conducted in Padova, Italy.
Dates to which data relate Effectiveness and resource data were collected between January 1993 and January 1994. The price date for costs of surgical supplies was December 1993.
Source of effectiveness data Link between effectiveness and cost data Costing was undertaken prospectively on the same patient sample as that used in the effectiveness study.
Study sample 38 female patients presenting signs of appendicitis, were assigned to one of two groups: open surgery (18) and laparoscopic surgery (20), according to the ability of the surgeon on duty to use laparoscopy. The two groups were comparable as regards age and clinical presentation of the disease.
Study design Non-randomised prospective controlled study. Duration of follow-up was not specified. There was no loss to follow-up.
Analysis of effectiveness The analysis of effectiveness was based on intention to treat. The primary health outcomes assessed in the review were the number of certain diagnoses and morbidity.
Effectiveness results Morbidity was comparable in the two groups:
2/20 in the laparoscopic group: phlebitis of the upper limb and leukocytosis and prolonged ileus in patients with preleukemic syndrome
3/18 in the surgical group: hyperpyrexia, respiratory insufficiency and metrorrhagia.
Laparoscopy enabled a higher number of certain diagnoses (9/10 vs 3/8, p>0.05).
Clinical conclusions Laparoscopy is a useful diagnostic tool in female patients suspected of appendicitis.
Measure of benefits used in the economic analysis Measures of benefits included: the need for analgesics, cosmetic result (score), and complication rates.
Direct costs Some costs and quantities were reported separately. Direct health services costs were considered such as cost of hospital stay, cost of operative room supplies and cost of operating room. Costs were based on actual data (unit of analysis). Costs were not discounted. The costs of surgical supplies were calculated according to prices in Italy in December 1993.
Statistical analysis of costs Data were analysed using a commercially available statistical package (Statgraphics, Plus Ware STSC). Findings were expressed as median and ranges. The Mann-Whitney and Fisher exact tests were used to compare the groups.
Currency Italian lire (1000 lire = 0.61US$)
Sensitivity analysis No sensitivity analysis was carried out.
Estimated benefits used in the economic analysis Mean figures were as follows for laparoscopic days versus open surgery days:
(a) need for analgesics: 15% versus 44.4%;
(b) cosmetic results 1.5 versus 2 points;
(c) complication rate: 10% versus 16%.
Cost results The mean total cost was higher for laparoscopic appendectomy than for conventional surgery (1,965,000 lire compared to 1,650,000 lire). The cost of surgical supplies for laparoscopic appendectomy was seven times higher than for open surgery. However, the cost of laparoscopic hospital stay was 25% less than that for open surgery (900,000 lire compared to 1,200,000 lire) and operating room costs were comparable. No discounting was stated.
Synthesis of costs and benefits At similar benefits, laparoscopic appendectomy was more expensive than conventional surgery for appendicitis in women.
Authors' conclusions Laparoscopy is a useful diagnostic tool in female patients, but laparoscopic appendectomy should be considered with some caution in times of restricted financial resources. Laparoscopy was more costly than open surgery, but had a 25% lower post-hospitalisation stay rate, a 29.4% lower need for analgesics, and a 6% lower complication rate than its comparator.
CRD Commentary The study failed to include the following: discounting, sensitivity analysis, and comprehensive cost information that may affect the strength of the authors' conclusions.
Bibliographic details Zaninotto G, Rossi M, Anselmino M, Costantini M, Pianalto S, Baldan N, Pizzato D, Ancona E. Laparoscopic versus conventional surgery for suspected appendicitis in women. Surgical Endoscopy - Ultrasound and Interventional Techniques 1995; 9(3): 337-340 Indexing Status Subject indexing assigned by NLM MeSH Acute Disease; Adult; Appendectomy /economics /methods; Appendicitis /diagnosis /surgery; Comparative Study; Costs and Cost Analysis; Female; Humans; Laparoscopy /economics; Length of Stay /statistics & Postoperative Complications /epidemiology; Prospective Studies; numerical data AccessionNumber 21995000339 Date bibliographic record published 30/09/1997 Date abstract record published 30/09/1997 |
|
|
|