Abstracts
1999 Digestive Disease Week

# 2116 A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS (RCT) ABOUT COST-EFFECTIVENESS OF LAPAROSCOPIC VERSUS CONVENTIONAL GENERAL SURGERY
T Strate, C Bloechle, K Gaward, Univ Hosp Hamburg, Hamburg Germany; Thomas Langwieler, J R Izbicki, Univ Hosp Hamburg-Eppendorf, Hamburg Germany

Background: Minimal invasive surgery (MIS) has revolutionized general surgery. In times of limited monetary resources in health care it seems to be essential to proof cost effectiveness of a new procedure (i.e. MIS) in comparison to the well established counterpart of conventional (conv.) surgery. Since RCT's can be considered the gold standard to evaluate new treatments, the aim of this study was to analyze well conducted RCT's that compare MIS and conv. general surgery regarding their cost effectiveness.
Methods: A MEDLINE research was conducted (1/1983 - 11/1998; german and english literature). Inclusion criteria were RCT's comparing MIS and its respective method. The retrieved studies were analyzed regarding their validity and allocated into either category (cat.) A (20-22 points, well conducted), cat B (17-19 points, appropriately conducted) and cat. C (<17 points, poorly conducted). The inter-individual variation of 3 independent surgeons was assessed to exclude biased judgment.
Results: Out of 70 RCT's (hernia repair (HR) n= 26, appendectomy (AE) = 17, cholecystectomy (CE) n= 17, colon resection n=7, fundoplication n = 2 and oversewing of perforated ulcer n = 1) costs were reported in only 14 studies (HR 9, AE 4, CE 1). Two studies were assigned cat. A (HR). Direct costs were higher in MIS (490,65US0. The indirect costs (only reported in one study) did not lead to a significant difference (MIS 105,20 US expensive). Both studies did not find significant differences regarding hernia recurrence while OR time, complications, pain and duration of hospitalization were judged contradictorily. This assessment of HR was supported by the lower classified studies (B=6, C=1) (MIS more expensive, contradictory results regarding complication, pain, duration of hospitalization and hernia recurrence with longer OR time for MIS). AE studies (C=6) reported on higher costs, longer OR time and less pain (MIS) with no difference regarding duration of hospitalization and reconvalescence. Only one study found less wound infections (MIS). The single report on CE (B) did also reveal higher costs and longer OR time for MIS, no difference in complication and reconvalescence, but lower pain and duration of hospitalization.
Conclusion: According to this analysis, only two out of 14 RCT's were well conducted. The only significant difference found in all studies was higher costs for the laparoscopic procedure. In HR there was no significant difference between the most important factor: hernia recurrence. In AE and CE, no parameter was identified to justify the higher costs associated with MIS. Analyzing RCT's, MIS was not found to be more cost-effective when compared to its conventional counterpart. In addition, the number of RCT's reporting on this topic. seems to be high, whereas their quality was found to be rather low.

Copyright 1996 - 1999, SSAT, Inc.