Cost comparison in routine care usage of laparoscopic lavage and resection in patients with perforated peritonitis
Carolina Ehrencrona, David Bock, Pia Johansson, Andreas Samuelsson, Eva HaglindAbstract
Introduction
In patients with perforated diverticulitis, Hinchey III, health economics analyses from randomized controlled trials have shown cost-benefits for laparoscopic lavage compared to resection surgery. The aim was to compare costs in routine care within a three-year national Swedish cohort.
Methods
Healthcare consumption (hospitalization, operations, days with stoma) from emergency surgery to two years postoperatively was compared for patients treated with laparoscopic lavage versus resection in Sweden 2016–2018, identified by in-patient registry and medical charts. Costs were valued by national prices for operations, regional health care price lists, and the literature. A double-robust weighted regression analysis was used. The groups (lavage n = 173, resection n = 291) were balanced with propensity score with inverse probability weighting and adjustment of the same factors. Costs were expressed in Swedish Krona (SEK) year 2020 and discounted 3%. Deterministic sensitivity analyses were implemented.
Results
Average total two-year healthcare costs were 195 500 SEK for laparoscopic lavage and 300 500 SEK for resection surgery. Weighted group cost-saving for patients treated initially by lavage with 63 000 SEK (95% c.i. −99 640: −26 290; P 0.001). Stoma-related costs represented the major cost difference; −22 870 SEK (95% c.i. −26 570: −19 170; P < 0.000). The lavage procedure was cost-saving compared to resection in sensitivity analyses of plausible cost ranges.
Discussion
The results from this national routine care cohort confirmed results from randomized trials, with lavage being cost-efficient as treatment for perforated diverticulitis with purulent peritonitis. Using lavage to a greater extent would be economically beneficial in a Swedish context.