Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer

The comparative costs of laparoscopy and laparotomy in surgical resection of colorectal cancer, especially of the hospital provider, have not yet been assessed in the perspective of the Italian National Healthcare System. This paper aims to fill this gap by providing economic information on this research topic of growing relevance at a time of reduced healthcare budgets. Three Italian reference centres retrospectively provided from their databases data on 90 cases of laparotomy (OP) or laparoscopy (LAP) interventions for right colon (RCol), left colon/sigma (LCol) and rectum (Rec). Costs were retrieved according to phases of the in-hospital procedure: pre-operative, operative and post-operative phase, including diagnostic work-up, hospital length of stay, duration of intervention, theatre occupation time, type of anaesthesia, medical devices and drugs used and staff time throughout the management process from hospital admission to discharge. The cost estimation was carried out using a microcosting, bottom-up technique, and statistical analysis was carried out using appropriate techniques. The average cost of colorectal surgery was a,not sign10,539/patient (median a,not sign10,396) with rectum procedures being statistically more costly than colon procedures (mean Rec a,not sign12,562/patient versus LCol a,not sign9,054 and RCol a,not sign10,002; median a,not sign11,704 versus a,not sign8,941 and a,not sign9,513, respectively; p < 0.0001). The average cost per patient did not differ between the two procedures for colon interventions, whereas a statistically significant difference was found for rectum procedures (LAP a,not sign11,617 versus OP a,not sign13,506; median a,not sign11,563 versus a,not sign12,568; p = 0.0442). The national diagnosis related groups (DRG) tariff is insufficient to remunerate the providers' activity, irrespective of the type of disease (surgical site) and surgical technique adopted. Colorectal cancer surgery is a costly procedure, and in-patient DRG tariffs are currently insufficient to cover the cost of its management for Italian hospital providers.