腹腔镜与开腹直肠前切除术的卫生经济学评价

Cost-effectiveness analysis of laparoscopic vs open anterior resection for rectal cancer

目的:比较腹腔镜和开腹直肠前切除术两种手术技术的费用以及卫生资源利用率。方法:将2003年1月至2005年5月我院收治的直肠癌病人前瞻性非随机分为腹腔镜组(87例)和开腹组(86例)。前瞻性比较两组的一般资料、手术资料、术后并发症料、直接与间接医疗费用以及直接医疗费用的构成。直接医疗费用包括手术材料费用、治疗药品费用、输血费用、住院费用、高能营养费用及处理术后并发症费用;间接医疗费用(病人和家属的误工费用)以误工天数乘以日平均收入计算。结果:腹腔镜组与开腹组直接医疗费用分别为26787.00(5036.00)元和24865.50(7422.00)元,两组无统计学差异;其中手术费用腹腔镜组为20332.17(1364.00)元,显著高于开腹组的7234.00(1793.29)元(P<0.01);药物治疗费用腹腔镜组3021.00(1364.00)元,显著低于开腹组的7234.00(4147.00)元(P<0.01);住院床位费用腹腔镜组为584.64(260.18)元,显著低于开腹组为834.24(389.21)元(P<0.01);两组的输血费用、高能营养费、处理术后并发症费用无明显差异。两组直接医疗费用的构成:腹腔镜组手术费、药品费和住院费分别69.07%、14.76%和2.18%,开腹组分别为45.43%、36.47%和3.35%。间接医疗费用腹腔镜组为1206.02(666.64)元,显著低于开腹组的2071.58(1071.21)(P<0.01)。结论:相对于开腹直肠前切除术,腹腔镜手术可通过减少药品费用、住院费用,缩短住院天数,加快床位周转,使卫生资源利用率更高,且能达到更低的间接医疗费用。

Objective To compare the cost and the composition of the direct cost of laparoscopic anterior resection for rectal cancer with those of the open laparotomy procedure. Methods From Jan. 2003 to May. 2005, 87 patients with rectal cancer underwent laparoscopic anterior resections of rectum （LAP）, while 86 cases were submitted open laparotomy procedures （OPEN）. The direct cost included the cost for operations, drugs, transfusion, nutritional support, days of hospi- talization, treatment for post-operative complications and reoperations, these items were prospectively evaluated;the indirect cost represented the loss of productivity caused by working days loss. The data of direct cost, indirect cost and the total cost were collected for analysis. The composition of the direct cost was analyzed to investigate the availability of the healthcare resources. Results The median direct cost were not significantly different between LAP and OPEN groups （26787.00 RMB vs 24865.50 RMB;P=0.375）. The indirect cost of the LAP group was significantly lower than that of the OPEN group （1,206.02 vs 2,071.58; P〈0.01）. And the total cost was not significantly different between the two （27922.64 vs 27054.42; P=-0.859）. The composition of the direct cost in the two groups was different. For the LAP group, the cost percentage for operations, drugs and hospitalization were 75.90%, 11.28% and 2.18% respectively; and for the OPEN group, there were 54.50%,29.09% and 3.35% respectively, the percentage occupied by the operation in the LAP group was higher, while the percentages caused by the drugs and hospitalization were much lower. Conclusions The total economical burden for the patients hospitalized in hospital was not significantly different between the LAP and OPEN groups. The availability of the health care resources was higher in the LAP group due to its technical predominance, and its shorter period of hospitalization.