Wipada Bintvihok and Tarinee Manchana*

Introduction: In Thailand, minimally invasive surgery for endometrial cancer has increased popularity over the years due to reduced pain, shorter hospital stay, and rapid recovery time without any effects on oncologic outcomes. However, the cost-effectiveness of this approach still remains unknown. We purposefully determine the cost-effectiveness of laparotomy, laparoscopic and robotic surgery in endometrial cancer patients.
Methods: An economic analysis based on our previously published retrospective study and cross-sectional study was conducted to compare total costs of three surgical approaches and health outcomes from both health care provider and patient perspective. Costing data were collected from clinical practice in King Chulalongkorn Memorial Hospital. Health outcomes were quantified in terms of complication-free rate, derived from published data and Quality of Life (QOL) assessed by a Thai version of the FACT-G questionnaire at 4 weeks after surgery. Incremental Cost-Effectiveness Ratios (ICERs) were used to compare costs per complication-free patient gained and costs per Quality-Adjusted Life Years (QALYs) gained. One-way and two-way sensitivity analyses were undertaken.
Results: Minimal invasive surgery was more costly compared to laparotomy but the utility of laparoscopy was more favorable. The mean utilities of robotic surgery, laparoscopic surgery and laparotomy were 0.90, 0.96, and 0.78, respectively. The incremental cost per QALYs gained ratio (ICER) of laparoscopic surgery compared with laparotomy was 1,444 Thai baht (43.2USD)/QALY in patient expense and 28,488 Thai baht (852.9USD)/QALY in health care medical cost. ICER of robotic surgery compared with laparotomy was 141,033 Thai baht (4,222.5USD)/QALY in patient expense and 268,578 Thai baht (8,041.3USD) /QALY in health care medical cost.
Conclusions: In Thailand, laparoscopic surgery in endometrial cancer was the most favorable and cost-effective surgical approach, whereas robotic surgery was the least cost-effective.
Keywords: Cost-effectiveness; Endometrial cancer; Laparotomy; Laparoscopy; Robotic surgery

Cite this Article: Bintvihok W, Manchana T. A Cost-Effectiveness Analysis of Laparotomy, Laparoscopic and Robotic Surgery in Endometrial Cancer. Sci JWomens Health Care. 2018;2(1): 001-006.

Published: 20 September 2018