腹腔镜与开腹胆囊切除术的卫生经济学评价

Cost-effectiveness analysis of laparoscopic vs open cholecystectomy

目的比较腹腔镜和开腹胆囊切除术两种手术技术的费用以及卫生资源利用率。方法将2007年1月～2008年12月该院收治的胆囊炎病人前瞻性非随机分为腹腔镜组(187例)和开腹组(178例)。前瞻性比较两组的一般资料、手术资料、术后并发症资料、直接与间接医疗费用。结果腹腔镜组直接医疗费用为(5330.5±536.74)元,显著高于开腹组(4651.96±508.77)元(P<0.05);其中手术费用和麻醉费用腹腔镜组为(1526.22±115.83)和(1618.34±237.72)元,显著高于开腹组的(762.52±231.65)和(1283.40±276.37)元(P<0.01);药物治疗费用腹腔镜组(712.12±279.66)元,显著低于开腹组的(1061.29±327.21)元(P<0.01);住院床位费用腹腔镜组为(252.61±36.65)元,显著低于开腹组为(337.30±59.84)元(P<0.05)。间接医疗费用腹腔镜组为(453.32±74.38)元,显著低于开腹组的(984.47±137.64)元(P<0.01)。总成本腹腔镜组为(5783.82±513.65)元与开腹组(5636.43±606.29)元相当(P>0.05)。结论相对于开腹胆囊切除术,腹腔镜手术通过减少药品费用、住院费用、缩短住院天数、加快床位周转,降低间接医疗费用从而提高卫生资源利用率。

[Objective] To compare the cost and effectiveness of the laparoscopic cholecystectomy versus open laparotomy procedure. [Methods] From Jan. 2007 to Dec. 2008, 187 patients underwent laparoscopic cholecystectomy （LC）, while 178 cases were submitted open cholecystectomy （0（2）. The direct cost for operations, drugs, nutritional support, days of hospitalization, treatment for postoperative complications and reoperations was prospectively evaluated; the indirect cost and the total cost were collected for analysis of investigation of the availability of the heathcare resources. [Results] The direct cost of LC [（5 330.5 ± 536.74） RMB] was significantly higher than that of OC [（4 651.96 ± 508.77） RMB, P 〈0.05]. The indirect cost of the LC group was significantly lower than that of the OC group [（453.32 ± 74.38） RMB versus （984.47 ± 137.64） RMB, P〈0.01]. And the total cost was not significantly different between LC and OC [（5 783.82 ± 513.65） RMB vs （5 636.43 ± 606.29） RMB, P 〉0.05]. The percentages occupied by the operation and anesthesia in the LC group was higher, while the percentages caused by the drugs and hospitalization were much lower. [ Conclusions] The total economical burden for the patients undergoing LC is similar to that of OC group. LC group has higher cost-effectiveness results compared to OC group.