Financial impact in the Italian Health Service of laparoscopic versus laparotomic surgery for the treatment of ovarian cysts

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Abstract
To assess the cost of two procedures for the removal of ovarian cysts, 200 pre-menopausal women were recruited for the surgical removal of ovarian cysts by laparoscopy (n = 100) and laparotomy (n = 100) according to case-control criteria. Patients operated by laparoscopy (mean age ± SD 32.22 ± 9.98 years) and laparotomy (mean age ± SD 29.57 ± 6.62 years) for ovarian cysts (mean diameters ± SD 4.98 ± 3.62 and 4.83 ± 2.78 cm) had a post-surgical hospital stay of 3.12 ± 0.41 and 735 ± 1.08 days (P < 0.001) respectively. The total rate of complications occurring in patients operated by laparoscopy was 9 versus 53% (P < 0.001) of those operated by laparotomy; body temperature >38°C was recorded in 52/100 of patients operated by laparotomy versus 6/100 of those operated by laparoscopy. The mean cost for each pure surgical treatment performed by laparoscopy was US $498.17 versus US $642.47 when it was performed by laparotomy (P < 0.001). The laparo-scopic surgical approach is more expensive in the first 36 operations, thereafter becoming cheaper. The mean of the entire overall expenditure was US $1142.08 and US $2138.72 for laparoscopy and laparotomy (P < 0.001) respectively. The entire expenditure for laparoscopy is higher than laparotomy only until eight operations. In conclusion, laparoscopy versus laparotomy has resulted in a saving of US $14 4293 for 100 operations while the saving on entire costs was US $99 664.8.

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