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

Background: 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.
Methods: 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.
Results: The average cost of colorectal surgery was euro 10,539/patient (median euro 10,396) with rectum procedures being statistically more costly than colon procedures (mean Rec euro 12,562/patient versus LCol euro 9,054 and RCol euro 10,002; median euro 11,704 versus euro 8,941 and euro 9,513, 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 euro 11,617 versus OP euro 13,506; median euro 11,563 versus euro 12,568; 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.
Conclusion: 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.