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Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis

Author

Listed:
  • Ioannis A. Ziogas

    (Vanderbilt University Medical Center
    Surgery Working Group, Society of Junior Doctors)

  • Alexandros P. Evangeliou

    (Surgery Working Group, Society of Junior Doctors
    Aristotle University of Thessaloníki School of Medicine)

  • Konstantinos S. Mylonas

    (Surgery Working Group, Society of Junior Doctors
    National and Kapodistrian University of Athens School of Medicine)

  • Dimitrios I. Athanasiadis

    (Surgery Working Group, Society of Junior Doctors
    Indiana University School of Medicine)

  • Panagiotis Cherouveim

    (Surgery Working Group, Society of Junior Doctors)

  • David A. Geller

    (University of Pittsburgh Medical Center)

  • Richard D. Schulick

    (University of Colorado Anschutz Medical Campus)

  • Sophoclis P. Alexopoulos

    (Vanderbilt University Medical Center)

  • Georgios Tsoulfas

    (Aristotle University of Thessaloniki School of Medicine)

Abstract

Background Following the publication of reports from landmark international consensuses (Louisville 2008 and Morioka 2014), minimally invasive hepatectomy became widely accepted as a legitimate alternative to open surgery. We aimed to compare the operative, hospitalization, and total economic costs of open (OLR) vs. laparoscopic (LLR) vs. robotic liver resection (RLR). Methods We performed a systematic literature review (end-of-search date: July 3, 2020) according to the PRISMA statement. Random-effects meta-analyses were conducted. Quality assessment was performed with the Cochrane Risk of Bias tool for randomized controlled trials, and the Newcastle–Ottawa Scale for non-randomized studies. Results Thirty-eight studies reporting on 3847 patients (1783 OLR; 1674 LLR; 390 RLR) were included. The operative costs of LLR were significantly higher than those of OLR, while subgroup analysis also showed higher operative costs in the LLR group for major hepatectomy, but no statistically significant difference for minor hepatectomy. Hospitalization costs were significantly lower in the LLR group, with subgroup analyses indicating lower costs for LLR in both major and minor hepatectomy series. No statistically significant difference was observed regarding total costs between LLR and OLR both overall and on subgroup analyses in either major or minor hepatectomy series. Meta-analyses showed higher operative, hospitalization, and total costs for RLR vs. LLR, but no statistically significant difference regarding total costs for RLR vs. OLR. Conclusion LLR’s higher operative costs are offset by lower hospitalization costs compared to OLR leading to no statistically significant difference in total costs, while RLR appears to be a more expensive alternative approach.

Suggested Citation

  • Ioannis A. Ziogas & Alexandros P. Evangeliou & Konstantinos S. Mylonas & Dimitrios I. Athanasiadis & Panagiotis Cherouveim & David A. Geller & Richard D. Schulick & Sophoclis P. Alexopoulos & Georgios, 2021. "Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(4), pages 585-604, June.
  • Handle: RePEc:spr:eujhec:v:22:y:2021:i:4:d:10.1007_s10198-021-01277-1
    DOI: 10.1007/s10198-021-01277-1
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    References listed on IDEAS

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    1. Jacques Marescaux & Joel Leroy & Michel Gagner & Francesco Rubino & Didier Mutter & Michel Vix & Steven E. Butner & Michelle K. Smith, 2001. "Transatlantic robot-assisted telesurgery," Nature, Nature, vol. 413(6854), pages 379-380, September.
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    More about this item

    Keywords

    Open liver resection; Laparoscopic liver resection; Robotic liver resection; Economic cost; Systematic review; Meta-analysis;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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