COST-EFFECTIVENESS OF REPLACING OPEN LIVER RESECTION WITH LAPAROSCOPIC LIVER RESECTION FOR PATIENTS WITH COLORECTAL LIVER METASTASES. ANALYSES PERFORMED ALONGSIDE A RANDOMIZED CONTROLLED TRIAL: THE OSLO-COMET STUDY

Purpose: 80-90% of liver resections are performed with open liver resections (OLR). Laparoscopic liver resection (LLR) might be a good alternative. The purpose of our study was to explore differences in resource use and costs between LLR and OLR in a randomized controlled trial (RCT), and to evaluate the cost-effectiveness of replacing OLR with LLR.

   Methods: Between February 2012 and February 2016, 274 patients with colorectal liver metastases (CLM) – who were eligible for cure by surgery – were randomized to OLR or LLR. We recorded all use of health care services at patient level using patients’ records and questionnaires up to 4 months after surgery. Use of disposable equipment for the initial surgery was collected in 80 patients using micro-costing, and extrapolated to the whole group. Also, resource use as a consequence of complications was estimated. Complications up to 30 days after surgery were recorded by a blinded assessor. Health related quality of life (HRQoL) was collected using the SF-36 v2 at the baseline, one and four-month follow-up. Costs were estimated in USD 2014. Differences were tested with Wilcoxon Rank-Sum Test.

   Results: Preliminary results imply equal costs between LLR and OLR ($11.719 LLR vs $10.944 OLR, p=0.101). However, the resource use between the groups differs: even though the surgeries on average had the same duration, disposable equipment were higher for LLR ($5,046 vs $4,230, p<0.001). LLR had a shorter length of stay in the postoperative care unit (4.6 hours ($812) vs. 5.6 hours ($994), p=0.002) and in the surgical ward (3.9 days ($3,463) vs 4.7 days ($4,183), <0.001). Three LLR and two OLR patients needed care in the intensive care unit, respectively. Fewer patients in the LLR group were discharged to another hospital for further treatment. However, the LLR patients who were discharged to another hospital had a longer stay than OLR patients. Due to limited time since inclusion stopped, the costs of complications and the Incremental Cost Effectiveness Ratio (ICER) have not yet been estimated. This will be done before the conference. Preliminary analyses imply similar HRQoL in the groups.

   Conclusion: Preliminary analyses show that the resource use between LLR and OLR differ, but that costs are equal. If HRQoL is also similar, LLR and OLR might seem as equally good alternatives.