Health economic analysis of laparoscopic lavage versus Hartmann's procedure for diverticulitis in the randomized DILALA trial

作者：Gehrman J^*; Angenete E; Bjorholt I; Bock D; Rosenberg J; Haglind E

来源：British Journal of Surgery, 2016, 103(11): 1539-1547.

DOI：10.1002/bjs.10230

BackgroundOpen surgery with resection and colostomy (Hartmann's procedure) has been the standard treatment for perforated diverticulitis with purulent peritonitis. In recent years laparoscopic lavage has emerged as an alternative, with potential benefits for patients with purulent peritonitis, Hinchey grade III. The aim of this study was to compare laparoscopic lavage and Hartmann's procedure with health economic evaluation within the framework of the DILALA (DIverticulitis-LAparoscopic LAvageversus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) trial.
MethodsClinical effectiveness and resource use were derived from the DILALA trial and unit costs from Swedish sources. Costs were analysed from the perspective of the healthcare sector. The study period was divided into short-term analysis (base-case A), within 12 months, and long-term analysis (base-case B), from inclusion in the trial throughout the patient's expected life.
ResultsThe study included 43 patients who underwent laparoscopic lavage and 40 who had Hartmann's procedure in Denmark and Sweden during 2010-2014. In base-case A, the difference in mean cost per patient between laparoscopic lavage and Hartmann's procedure was Euro-8983 (95 per cent c.i. -16232 to -1735). The mean(s.d.) costs per patient in base-case B were Euro25703(27544) and Euro45498(38928) for laparoscopic lavage and Hartmann's procedure respectively, resulting in a difference of Euro-19794 (95 per cent c.i. -34657 to -4931). The results were robust as demonstrated in sensitivity analyses.
ConclusionThe significant cost reduction in this study, together with results of safety and efficacy from RCTs, support the routine use of laparoscopic lavage as treatment for complicated diverticulitis with purulent peritonitis.
In favour of lavage

• 出版日期2016-10