The cost-effectiveness of minimally invasive esophagectomy for esophageal cancer, a cost analysis of a randomized controlled trial

Introduction Minimally invasive esophagectomy (MIE) is associated with less pulmonary complications, shorter hospital stay, and better quality of life as compared to open esophagectomy (OE). However, there are concerns about the likely higher costs for this procedure. Therefore, we carried out an economic evaluation of the randomized controlled TIME trial in MIE was compared to OE in patients with curable esophageal cancer. Methods The economic evaluation combined a cost-effectiveness analysis and a cost-benefit analysis in the comparison of MIE with OE within a time-period of 30 days postoperatively. Cost data was prospectively measured by registration of detailed intervention units per patient, thereby obtaining the actual resourceuse scores per individual patient. The cost-benefit analysis entailed comparing the difference between MIE and OE in operation-related costs with their difference in post operative costs during the 30-days post operative period. The cost-effectiveness analysis entailed comparing differences in total costs with differences in quality of life domains. Uncertainties regarding the cost and effect differences were estimated by bootstrapping and graphically represented on planes. Results The difference in total healthcare costs between MIE and OE was small and not statistically significant. The cost-effectiveness plane indicated that improvements in quality of life could be achieved at limited or no costs. Conclusion Total healthcare costs holding for MIE or OE procedures are similar. Minimally invasive esophagectomy is favored over the open procedure because of better quality of life effects and less post operative complications. The cost-effectiveness of minimally invasive esophagectomy for esophageal cancer, a cost analysis of a randomized controlled trial. 141