Costs and benefits of laparoscopic surgery - a review of the literature

The purpose of this paper is to look at the cost-effectiveness of laparosco pic surgery in relation to conventional open surgery. It focuses both on th e results and the methods, and aims to identify the need for further studie s as well as the appropriate methods of economic evaluation. We searched th e literature and identified studies in which "cost" or "cost-effectiveness" was mentioned in relation to open and laparoscopic surgery. Laparoscopic a nd open surgery were compared for gallbladder disease, inguinal hernia and gastro-oesophageal reflux disease (GORD). Finally, we reviewed studies that focused on cost comparisons of disposable compared with reusable instrumen ts in laparoscopic surgery. We found that the evidence on whether laparosco pic surgery results in lower costs for the health care system than open ope rations is not conclusive. There are, however, indications that it results in savings in indirect costs from reduced periods of sick leave. There is a lso an indication that reusable instruments resulted in lower costs for eac h operation than disposable instruments. We conclude that a prospective, randomised study is the preferred study des ign in the early stage of the development of a new technique, when it is no t fully obvious what the indications for the new technique are. This should be considered when doing economic evaluations of new indications for lapar oscopic surgery, for example appendicectomy and non-inguinal hernia repair.