Cost Differences Between Open and Minimally Invasive Surgery.

Area of Science:

• Health Economics
• Surgical Outcomes
• Comparative Effectiveness

Background:

• Minimally invasive surgery (MIS) offers potential benefits over traditional open surgical approaches.
• Understanding the cost implications for commercial payers is crucial for healthcare policy and resource allocation.

Purpose of the Study:

• To compare the cost-effectiveness of minimally invasive surgery (MIS) versus open surgery for four common procedures: colectomy, ventral hernia repair, thoracic resection, and hysterectomy.
• To analyze these costs from the perspective of a commercial health insurance payer.

Main Methods:

• Retrospective analysis of claims data from the 2011-2012 Truven Health Analytics MarketScan database.
• Inclusion criteria: patients aged 18-64 with pharmacy coverage and continuous eligibility in 2012, undergoing one of the four target procedures.
• Calculated average allowed costs (facility and professional) during the perioperative period (inpatient stay or day of surgery and 30 days post-discharge), adjusting for patient demographics, comorbidities, cancer presence, and geographic region.

Main Results:

• The study analyzed 46,386 surgical cases.
• Adjusted analysis revealed significant cost differences favoring MIS: colectomy ($10,204 less), ventral hernia repair ($3,721 less), thoracic resection ($12,989 less), and noncancer hysterectomy ($1,174 less).
• Post-discharge costs also showed savings for MIS in colectomy ($1,494) and ventral hernia repair ($1,320), with non-significant differences for thoracic resection and hysterectomy.

Conclusions:

• Minimally invasive surgery (MIS) is associated with statistically significant lower overall costs compared to open surgery across all four analyzed procedures.
• These findings support the adoption of MIS from a commercial payer's economic standpoint.
• The study underscores the economic advantages of MIS in major surgical interventions.