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Cost-Effectiveness of Laparoscopic vs Open Liver Resection: A Propensity Score-Matched Single-Center Analysis of 920
Ye Xin Koh1,2,3, Yun Zhao4, Ivan En-Howe Tan4
1From the Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore (Koh, HL Tan, Chua, EK Tan, JY Teo, Goh).
Background:
This study compared the clinical and economic outcomes of laparoscopic (LLR) and open liver resection (OLR) for all hepatectomies, including minor and major hepatectomy.
Study Design:
This retrospective study included 920 consecutive elective patients undergoing liver resection from 2017 to 2023. Patient demographics, postoperative surgical outcomes, postoperative length of stay (LOS), and cost were compared between LLR and OLR before and after propensity score matching (PSM). A decision model was developed to assess the cost-effectiveness of LLR vs OLR.
Results:
After PSM, LLR was associated with significantly fewer postoperative transfusions for all hepatectomies (p < 0.001) and major hepatectomy (p = 0.001). LLR was associated with a shorter postoperative median LOS (p < 0.001), lower 30-day readmission (p = 0.022) and reoperation (p = 0.044) rate, and significantly reduced postoperative pneumonia (p = 0.038), unplanned intubation (p = 0.020), sepsis (p = 0.041), and major complication (p < 0.001) for all hepatectomies. This clinical superiority was complemented by a significant reduction in total cost for all (p < 0.001), minor (p = 0.001), and major (p < 0.001) hepatectomy. Cost-effectiveness analysis revealed that LLR was dominant over OLR, with a negative incremental cost-effectiveness ratio (-$2,120.72) and an increased net monetary benefit ($75,015.92) at the willingness-to-pay threshold of $25,000. The probability of LLR being cost-effective was 99.8% across various willingness-to-pay thresholds.
Conclusions:
LLR is a safe and cost-effective alternative to OLR. Although LLR has higher initial procedural costs, these are offset by significant reduction in postoperative major complication, LOS, and total cost.
