Economic evaluation of laparoscopic surgery for colorectal cancer

Objectives: To assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer. Methods: A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life year gained and using cost-effectiveness acceptability curves (CEACs) to illustrate the likelihood that a treatment was cost-effective at various threshold values for society’s willingness to pay for an additional life year. Results: Laparoscopic surgery was on average £300 more costly and slightly less effective than open surgery and had a 30% chance of being cost-effective if society is willing to pay £30,000 for a life year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality adjusted life year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits following laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective. Conclusions: Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes and an additional £300 per patient. A judgement is required as to whether the short-term benefits are worth this extra cost.Peer reviewedAuthor versio

Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer

Objective Colorectal cancer is one of the most common cancers and the standard surgical treatment for this cancer is open resection (OS), but laparoscopic surgery (LS) may be an alternative treatment. In 2000, a Health Technology Assessment (HTA) review found little evidence on costs and cost-effectiveness in comparing the two methods. The evidence base has since expanded and this study systematically reviews the economic evaluations on the subject published since 2000. Method Systematic review of studies reporting costs and outcomes of LS vs OS for colorectal cancer. National Health Service Economic Evaluation Database (NHS EED) methods for abstract writing were followed. Studies were summarized and incremental cost-effectiveness ratios (ICER) for common outcomes were calculated. Results Five studies met the inclusion criteria. LS generally had higher healthcare costs. Most studies reported longer operational time and shorter length of stay and similar long-term outcomes with LS vs OS. Only one outcome, complications, was common across all studies but results lacked consistency (e.g. in two studies, OS was less costly but more effective; in another study, LS was less costly but more effective; and in the further two studies, LS could potentially be cost effective depending on the decision-makers' willingness to pay for the health gain). Conclusion The evidence on cost-effectiveness is not consistent. LS was generally more costly than OS. However, the effectiveness data used in individual economic evaluation were imprecise and unreliable when compared with data from systematic reviews of effectiveness. Nevertheless, short-term benefits of LS (e.g. shorter recovery) may make LS appear less costly when productivity gains are considered.Department of Health, National Coordinating Centre for Health Technology Assessment, Chief Scientist Office of the Scottish Government Health DirectoratesPeer reviewedAuthor versio

Evacuation and Return: Increasing Safety and Reducing Risk

The City of New Orleans enlisted UNO-CHART to improve the evacuation of the vulnerable populations in the city, defined broadly to include those who are not able to access or use the standard resources offered in disaster preparedness and planning, response, and recovery. To do this, UNO-CHART analyzed the Regional Transit Authority (RTA), the City Assisted Evacuation Plan (CAEP) and Special Needs Registry databases, conducted a literature review of risk communication best practices, reviewed ready.nola.gov for content and readability, conducted a social vulnerability analysis of the Evacuspots, conducted interviews and focus groups with vulnerable populations in the City of New Orleans, and evaluated the CAEP full scale exercise. UNO-CHART conducted these analyses in order to examine the transportation needs of vulnerable populations on an everyday basis and during a disaster event, and how the city’s services currently meets those needs. The project team discovered that while many members of vulnerable populations use public transportation on a daily basis, there are issues with obtaining transportation during a disaster. The issues stem from a lack of resident knowledge about the City Assisted Evacuation (CAE) process, locations of Evacuspots, accessibility and cultural competence of the CAE, and trust in the city to effectively bring vulnerable populations to safety. Residents detailed many different ways the city can build on the past to create community solutions. The following report details recommendations for how to make residents more aware of the CAEP, make Evacuspots more accessible, better plan for the city’s most vulnerable, integrate cultural competence into the CAEP, and build trust in self-reliant populations

LA SAFE – Louisiana’s Strategic Adaptations for Future Environments: The Collective Search for Common Ground

In coastal Louisiana, subsidence and sea level rise, plus the threat of hurricanes and flooding, combine to create one of the highest rates of relative sea level rise in the world (Penland & Ramsey, 1990). To help address these issues, the National Disaster Resilience Competition (NDRC), sponsored by the U.S. Department of Housing and Urban Development (HUD) and the Rockefeller Foundation, awarded funding for LA SAFE – Louisiana’s Strategic Adaptations for Future Environments. The LA SAFE program, a partnership between the Office of Community Development (OCD) and the Foundation for Louisiana (FFL), supported an inclusive public process to identify adaptation strategies to enhance the resilience of coastal Louisiana. This public process involved the six parishes most impacted by Hurricane Isaac in 2012: Jefferson, Lafourche, Plaquemines, St. John the Baptist, St. Tammany, and Terrebonne. Throughout the planning and implementation process, UNO-CHART conducted an evaluation in an iterative manner that allowed for continual feedback. The evaluation was a mixed methods process that included both qualitative and quantitative measures, involving both process and outcome measures

LA SAFE – Louisiana’s Strategic Adaptations for Future Environments: The Collective Search for Common Ground

In coastal Louisiana, subsidence and sea level rise, plus the threat of hurricanes and flooding, combine to create one of the highest rates of relative sea level rise in the world (Penland & Ramsey, 1990). To help address these issues, the National Disaster Resilience Competition (NDRC), sponsored by the U.S. Department of Housing and Urban Development (HUD) and the Rockefeller Foundation, awarded funding for LA SAFE – Louisiana’s Strategic Adaptations for Future Environments. The LA SAFE program, a partnership between the Office of Community Development (OCD) and the Foundation for Louisiana (FFL), supported an inclusive public process to identify adaptation strategies to enhance the resilience of coastal Louisiana. This public process involved the six parishes most impacted by Hurricane Isaac in 2012: Jefferson, Lafourche, Plaquemines, St. John the Baptist, St. Tammany, and Terrebonne. Throughout the planning and implementation process, UNO-CHART conducted an evaluation in an iterative manner that allowed for continual feedback. The evaluation was a mixed methods process that included both qualitative and quantitative measures, involving both process and outcome measures

Alternatives to Animal Use in Research, Testing, and Education

In this assessment, OTA analyzes the scientific, regulatory, economic, legal, and ethical considerations involved in alternative technologies in biomedical and behavioral research, toxicity testing, and education. Included is a detailed examination of Federal, State, and institutional regulation of animal use, and a review of recent developments in 10 other countries. The report was requested by Sen. Orrin Hatch, Chairman of the Senate Committee on Labor and Human Resources

Environmental Technology: Analysis of Selected Federal R&D Programs

This report discusses estimates of environmental technology R&D spending, interagency coordination mechanisms, and major federal programs, including programs administered by the Department of Energy, the Department of Defense, the Environmental Protection Agency, and several other agencies

Oil Transportation by Tankers: An Analysis of Marine Pollution and Safety Measures

A report prepared by the Office of Technology Assessment (OTA) presenting "a factual background on tankers and a discussion of issues related to the safety of tanker operation and the potential presented by tankers for introducing polluting oil into the marine environment" (p. xv). The report investigates broad issues and suggests possible alternatives

The Implications of Cost-Effectiveness Analysis of Medical Technology

A report by the Office of Technology Assessment (OTA) that compares and assesses different methods of treating periodontal disease (p. 3)