Title: Cost analysis of laparoscopic lavage compared with sigmoid resection for perforated diverticulitis in the Ladies trial

Abstract

Abstract Background Laparoscopic peritoneal lavage is an alternative to sigmoid resection in selected patients presenting with purulent peritonitis from perforated diverticulitis. Although recent trials have lacked superiority for lavage in terms of morbidity, mortality was not compromised, and beneficial secondary outcomes were shown. These included shorter duration of surgery, less stoma formation and less surgical reintervention (including stoma reversal) for laparoscopic lavage versus sigmoid resection respectively. The cost analysis of laparoscopic lavage for perforated diverticulitis in the Ladies RCT was assessed in the present study. Methods This study involved an economic evaluation of the randomized LOLA (LaparOscopic LAvage) arm of the Ladies trial (comparing laparoscopic lavage with sigmoid resection in patients with purulent peritonitis due to perforated diverticulitis). The actual resource use per individual patient was documented prospectively and analysed (according to intention-to-treat) for up to 1 year after randomization. Results Eighty-eight patients were randomized to either laparoscopic lavage (46) or sigmoid resection (42). The total medical costs for lavage were lower (mean difference € − 3512, 95 per cent bias-corrected and accelerated c.i. −16 020 to 8149). Surgical reintervention increased costs in the lavage group, whereas stoma reversal increased costs in the sigmoid resection group. Differences in favour ofmore » laparoscopy were robust when costs were varied by ±20 per cent in a sensitivity analysis (mean cost difference € − 2509 to −4438). Conclusion Laparoscopic lavage for perforated diverticulitis is more cost-effective than sigmoid resection.« less

Authors:

Vennix, S.; van Dieren, S.; Opmeer, B. C.; Lange, J. F.; Bemelman, W. A.

Publication Date:

Wed Dec 21 00:00:00 EST 2016

Sponsoring Org.:

USDOE Office of Electricity (OE), Advanced Grid Research & Development. Power Systems Engineering Research

OSTI Identifier:

1336956

Alternate Identifier(s):

OSTI ID: 1348244

Grant/Contract Number:  

ZonMW 171002213

Resource Type:

Published Article

Journal Name:

British Journal of Surgery

Additional Journal Information:

Journal Name: British Journal of Surgery Journal Volume: 104 Journal Issue: 1; Journal ID: ISSN 0007-1323

Publisher:

Oxford University Press

Country of Publication:

United Kingdom

Language:

English