The economics of laparoscopic surgery

With the increase in technology, there has been increased emphasis on proving cost effectiveness in a variety of medical therapies. Probably nowhere is this more true than in the laparoscopic management of a variety of intra-abdominal diseases. The obvious implication is that a new therapy must either be vastly superior if it is more expensive, or at least equal in efficacy if it is less expensive, to gain widespread usage. In laparoscopic surgery, there are strategies for cost management that can be divided into surgery-related variables, equipment-related variables, and society benefits. The surgeon obviously has control over instrumentation usage, the operative duration, and the risk of operative complications. Careful attention to improving technical skill, with the reduction in both complications and operative times, can have a significant impact on the cost of laparoscopic procedures. In addition, the postoperative management can be very different from the usual open cases because another source of cost savings is the reduction in hospital stay. Equipment-related variables are another area of concern. This includes a discussion regarding the optimal application of reusable versus disposable instrumentation. Although there are arguments on both sides, in general, reusable equipment is less expensive. Finally, there can be significant savings in cost with reduced periods of convalescence related to most laparoscopic procedures when compared with their open counterparts. However, in the United States this benefit is only realized by the employer and not the health insurance company. It is important for surgeons to understand the analysis of cost effectiveness and apply it to new technologies so true advances can be made available as quickly as possible. Alternatively, interventions that are simply more expensive may be abandoned earlier.