Abstract
Background
Laparoscopic Nissen fundoplication (LNF) has essentially replaced its conventional open counterpart (CNF). An economic evaluation of LNF compared with CNF based on prospective data with adequate follow-up is lacking.
Methods
Data from two consecutive studies (a randomized clinical trial (RCT) of 57 patients undergoing LNF and 46 undergoing CNF that was terminated prematurely, and a follow-up study of 121 consecutive patients with LNF) were combined to determine incremental cost-effectiveness 1 year after surgery.
Results
Mean operating time, reoperation rate and hospital costs of LNF were lower in the second series. The mean overall hospital cost per patient was โฌ9126 for LNF and โฌ6989 for CNF at 1 year in the initial RCT, and โฌ7782 in the second LNF series. The success rate of both LNF and CNF at 1 year was 91 per cent in the RCT, and LNF was successful in 90ยท1 per cent in the second series. A cost reduction of โฌ998 for LNF would cancel out the cost advantage of CNF. Similarly, if the reoperation rate after LNF decreased from 0ยท05 to below 0ยท008 and/or if the mean duration of sick leave after LNF was reduced from 67ยท2 to less than 61ยท1 days, the procedure would become less expensive than CNF. Complications, reoperation rate and quality of life after both operations were similar.
Conclusion
Including reinterventions, the outcome at 1 year after LNF and CNF was similar. In a well organized setting with appropriate expertise, the cost advantage of CNF may be neutralized.