Cost-effectiveness of open versus laparoscopic pancreatectomy: A population-based study using data from the korea national health insurance service

Abstract

Introduction: It has been shown that laparoscopic pancreatic resection (LPR) is comparable to open pancreatic resection (OPR). How-ever, cost-effectiveness analysis of LPR is rare. We performed a population-based study on the cost-effectiveness of LPR versus OPR. Methods: Data of 9,255 patients who received pancreaticoduodenectomy (PD) (66.8%) and distal pancreatectomy (DP) (33.2%) from 2016 to 2018 were retrieved from the National Health Insurance Service. Events after pancreatectomy were categorized as no complica-tions, intervention, reoperation, and death. Probabilities of each event and average cost during index admission (IA) and postoperative 1 year (Po1Y) were utilized to calculate incremental cost effectiveness ratio (ICER), the cost difference between two interventions di-vided by quality adjusted life year (QALY). QALY, a function of length and quality of life, was measured with utility values determined by researching literature. Results: LPR was performed in 8.2% of PDs and 17.8% of DPs. For PD, LPR was associated with an increase of 0.0404 QALYs for IA and 0.0127 QALYs for Po1Y compared with OPR. Incremental cost was 421,917 KRW for IA and-1,860,579 KRW for Po1Y, leading to an ICER of 10,437,432 KRW per QALY gained for IA and-146,752,689 KRW per QALY gained for Po1Y. For DP, LPR improved 0.0909 QALYs for IA and 0.0469 QALYs for Po1A. Incremental cost was-1,632,107 KRW for IA and-7,730,674 KRW for Po1Y, leading to an ICER of-17,954,499KRW per QALY gained for IA and-164,990,346 KRW for Po1Y. Conclusions: Except initial higher cost of LPR, LPR was a cost-effective alternative to OPR for PD and DP.