| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Background: Due to the increasing incidence rate of colorectal cancer in Taiwan, and spend a tremendous amount of medical utilizations under National Health Insurance (NHI) every year, colorectal cancer has become one of the most important health issue that people and government should be concerned. The most commonly used treatment for colorectal cancer is by surgery. In addition to the open surgery, the technology of laparoscopic surgery is now more mature, and has been used more frequently to treat the colorectal patients in recent years. However, there is yet enough retrospective study on the clinical outcomes, medical costs and cost-effectiveness analysis between laparoscopic surgery and open surgery on colon cancer patients using the National Health Insurance Research Database (NHIRD) in Taiwan.
Objective: The aim of the study is to compare the difference in clinical outcome and medical costs between laparoscopic and open surgery, and to estimate the cost-effectiveness between laparoscopic and open surgery from the perspective of National Health Insurance in Taiwan.
Methods: This study used the 2010 Longitudinal Health Insurance Database (LHID2010) of NHIRD. We selected only newly diagnosed cases who received a laparoscopic or open surgery from 2007 to 2012, and compared the difference of the length of stay, number of complications cases within 30 days, number of readmission within 30 days, number of death within 1 year, overall 3-year survival and recurrence-free 3-year survival, and medical costs of hospitalization of surgery. We conducted logistic regression to calculate the propensity score for 1:1 matching (PSM). The chi-square test, Wilcoxon rank-sum test, generalized estimating equation (GEE), cox proportional hazards regression and Kaplan-Meier survival curve were used to compare the difference in clinical outcomes and medical costs. Incremental cost-effectiveness ratio (ICER) was calculated in cost-effectiveness analysis. This study also conducted one-way sensitivity analysis and non-parametric bootstrap to estimate the distribution of ICER.
Results: There were 125 patients in each of the laparoscopic surgery and open surgery group after PSM and there were no differences in the baseline characteristics between these two groups. The length of stay were 3.6 days shorter for laparoscopic (p <0.001). The number of complication cases within 30 days were 15 and 19 cases, the number of readmission within 30 days were 6 and 10 cases, and the number of death within 1 year were 2 and 3 cases for laparoscopic surgery and open surgery, respectively. Overall 3-year survival (p =0.827) and recurrence-free 3-year survival (p =0.689) are similar for the two groups. In medical costs analysis, laparoscopic surgery patients saved NT$3,280 for medical costs of hospitalization of surgery and NT$11,569 for medical costs within 1 year. Colon cancer related medical costs within 1 year of laparoscopic surgery patients were NT$9,239 higher than that of open surgery patients, however the difference was not significant. For cost-effectiveness analysis, compared to open surgery, laparoscopic surgery was the dominant treatment option.
Conclusions: In general, laparoscopic surgery had better clinical outcomes and also lower medical costs comparing to open surgery. Therefore, laparoscopic surgery was a dominant treatment option on colon cancer patients from the perspective of NHI administration.
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