Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

J. van Hilst; E. A. Strating; T. de Rooij; F. Daams; S. Festen; B. Groot Koerkamp; J. M. Klaase; M. Luyer; M. G. Dijkgraaf; M. G. Besselink; H. C. van Santvoort; M. T. de Boer; D. Boerma; P. B. van den Boezem; R. M. van Dam; C. H. Dejong; E. B. van Duyn; C. H. van Eijck; M. F. Gerhards; I. H. de Hingh; G. Kazemier; R. H. de Kleine; C. J. van Laarhoven; G. A. Patijn; P. Steenvoorde; M. Suker; M. Abu Hilal; Dutch Pancreatic Canc Grp; LEOPARD trial collaborators

doi:10.1002/bjs.11147

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

J. van Hilst, E. A. Strating, T. de Rooij, F. Daams, S. Festen, B. Groot Koerkamp, J. M. Klaase, M. Luyer, M. G. Dijkgraaf, M. G. Besselink^*, H. C. van Santvoort, M. T. de Boer, D. Boerma, P. B. van den Boezem, R. M. van Dam, C. H. Dejong, E. B. van Duyn, C. H. van Eijck, M. F. Gerhards, I. H. de HinghG. Kazemier, R. H. de Kleine, C. J. van Laarhoven, G. A. Patijn, P. Steenvoorde, M. Suker, M. Abu Hilal, Dutch Pancreatic Canc Grp, LEOPARD trial collaborators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established.

Methods: The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost-utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year.

Results: All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference (si27 (95 per cent bias-corrected and accelerated confidence interval (sic)-4700 to 3613; P = 0.839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0.566 of being more cost-effective than the open approach at a willingness-to-pay threshold of (sic) per day of earlier recovery, and a probability of 0.676 per additional quality-adjusted life-year at a willingness-to-pay threshold of (sic) 80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i. q. r. 5.75-10) versus 7 (4-8.75); P = 0.056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy.

Conclusion: Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

Original language	English
Pages (from-to)	910-921
Number of pages	12
Journal	British Journal of Surgery
Volume	106
Issue number	7
DOIs	https://doi.org/10.1002/bjs.11147
Publication status	Published - Jun 2019

Keywords

INTERNATIONAL STUDY-GROUP
OPEN ILEOCOLIC RESECTION
BODY-IMAGE
SURGERY
COSMESIS
DEFINITION

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van Hilst, J., Strating, E. A., de Rooij, T., Daams, F., Festen, S., Koerkamp, B. G., Klaase, J. M., Luyer, M., Dijkgraaf, M. G., Besselink, M. G., van Santvoort, H. C., de Boer, M. T., Boerma, D., van den Boezem, P. B., van Dam, R. M., Dejong, C. H., van Duyn, E. B., van Eijck, C. H., Gerhards, M. F., ... LEOPARD trial collaborators (2019). Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial). British Journal of Surgery, 106(7), 910-921. https://doi.org/10.1002/bjs.11147

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title = "Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)",

abstract = "Background: Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established.Methods: The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost-utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year.Results: All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference (si27 (95 per cent bias-corrected and accelerated confidence interval (sic)-4700 to 3613; P = 0.839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0.566 of being more cost-effective than the open approach at a willingness-to-pay threshold of (sic) per day of earlier recovery, and a probability of 0.676 per additional quality-adjusted life-year at a willingness-to-pay threshold of (sic) 80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i. q. r. 5.75-10) versus 7 (4-8.75); P = 0.056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy.Conclusion: Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.",

keywords = "INTERNATIONAL STUDY-GROUP, OPEN ILEOCOLIC RESECTION, BODY-IMAGE, SURGERY, COSMESIS, DEFINITION",

author = "{van Hilst}, J. and Strating, {E. A.} and {de Rooij}, T. and F. Daams and S. Festen and Koerkamp, {B. Groot} and Klaase, {J. M.} and M. Luyer and Dijkgraaf, {M. G.} and Besselink, {M. G.} and {van Santvoort}, {H. C.} and {de Boer}, {M. T.} and D. Boerma and {van den Boezem}, {P. B.} and {van Dam}, {R. M.} and Dejong, {C. H.} and {van Duyn}, {E. B.} and {van Eijck}, {C. H.} and Gerhards, {M. F.} and {de Hingh}, {I. H.} and G. Kazemier and {de Kleine}, {R. H.} and {van Laarhoven}, {C. J.} and Patijn, {G. A.} and P. Steenvoorde and M. Suker and {Abu Hilal}, M. and {Dutch Pancreatic Canc Grp} and {LEOPARD trial collaborators}",

note = "Funding Information: M.G.D. and M.G.B. are joint senior authors of this article. An investigator-initiated research grant (IIS 14-702) was received from Ethicon Endo-surgery (Johnson & Johnson, New Brunswick, New Jersey, USA). M.G.B. reports receiving consulting and lecturing fees from Ethicon Endo-Surgery. Publisher Copyright: {\textcopyright} 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.",

year = "2019",

month = jun,

doi = "10.1002/bjs.11147",

language = "English",

volume = "106",

pages = "910--921",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "7",

}

van Hilst, J, Strating, EA, de Rooij, T, Daams, F, Festen, S, Koerkamp, BG, Klaase, JM, Luyer, M, Dijkgraaf, MG, Besselink, MG, van Santvoort, HC, de Boer, MT, Boerma, D, van den Boezem, PB, van Dam, RM, Dejong, CH, van Duyn, EB, van Eijck, CH, Gerhards, MF, de Hingh, IH, Kazemier, G, de Kleine, RH, van Laarhoven, CJ, Patijn, GA, Steenvoorde, P, Suker, M, Abu Hilal, M, Dutch Pancreatic Canc Grp & LEOPARD trial collaborators 2019, 'Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)', British Journal of Surgery, vol. 106, no. 7, pp. 910-921. https://doi.org/10.1002/bjs.11147

TY - JOUR

T1 - Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

AU - van Hilst, J.

AU - Strating, E. A.

AU - de Rooij, T.

AU - Daams, F.

AU - Festen, S.

AU - Koerkamp, B. Groot

AU - Klaase, J. M.

AU - Luyer, M.

AU - Dijkgraaf, M. G.

AU - Besselink, M. G.

AU - van Santvoort, H. C.

AU - de Boer, M. T.

AU - Boerma, D.

AU - van den Boezem, P. B.

AU - van Dam, R. M.

AU - Dejong, C. H.

AU - van Duyn, E. B.

AU - van Eijck, C. H.

AU - Gerhards, M. F.

AU - de Hingh, I. H.

AU - Kazemier, G.

AU - de Kleine, R. H.

AU - van Laarhoven, C. J.

AU - Patijn, G. A.

AU - Steenvoorde, P.

AU - Suker, M.

AU - Abu Hilal, M.

AU - Dutch Pancreatic Canc Grp

AU - LEOPARD trial collaborators

N1 - Funding Information: M.G.D. and M.G.B. are joint senior authors of this article. An investigator-initiated research grant (IIS 14-702) was received from Ethicon Endo-surgery (Johnson & Johnson, New Brunswick, New Jersey, USA). M.G.B. reports receiving consulting and lecturing fees from Ethicon Endo-Surgery. Publisher Copyright: © 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

PY - 2019/6

Y1 - 2019/6

N2 - Background: Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established.Methods: The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost-utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year.Results: All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference (si27 (95 per cent bias-corrected and accelerated confidence interval (sic)-4700 to 3613; P = 0.839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0.566 of being more cost-effective than the open approach at a willingness-to-pay threshold of (sic) per day of earlier recovery, and a probability of 0.676 per additional quality-adjusted life-year at a willingness-to-pay threshold of (sic) 80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i. q. r. 5.75-10) versus 7 (4-8.75); P = 0.056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy.Conclusion: Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

AB - Background: Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established.Methods: The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost-utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year.Results: All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference (si27 (95 per cent bias-corrected and accelerated confidence interval (sic)-4700 to 3613; P = 0.839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0.566 of being more cost-effective than the open approach at a willingness-to-pay threshold of (sic) per day of earlier recovery, and a probability of 0.676 per additional quality-adjusted life-year at a willingness-to-pay threshold of (sic) 80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i. q. r. 5.75-10) versus 7 (4-8.75); P = 0.056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy.Conclusion: Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

KW - INTERNATIONAL STUDY-GROUP

KW - OPEN ILEOCOLIC RESECTION

KW - BODY-IMAGE

KW - SURGERY

KW - COSMESIS

KW - DEFINITION

U2 - 10.1002/bjs.11147

DO - 10.1002/bjs.11147

M3 - Article

C2 - 31012498

SN - 0007-1323

VL - 106

SP - 910

EP - 921

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 7

ER -

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

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Keywords

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