IDDF2019-ABS-0344 Exemplifying direct inpatient cost for laparoscopic management of left colonic malignancy at a tertiary care teaching hospital in india

Background Laparoscopic management of colorectal cancer (CRC) has been gaining popularity at a rapid pace across the world. Proponents argue for better short term outcomes including shorter hospital stay, acceptable safety profile and better outcomes of laporoscopic versus open surgery. However, the direct inpatient cost for laparoscopic management of CRC remains unexplored. This assumes even more importance in resource-strapped economies like India. Methods A cross-sectional study was carried out with a hospital discharge diagnosis of CRC (ICD-10 C18-C19) from 2015–2018. Patient details on surgery, investigations, days of hospitalization, and drugs from hospital admission to discharge were obtained precisely from the medical records department. Item costs were obtained from the hospital electronic billing section. Economic evaluation included a prevalence-based approach with a societal perspective utilizing the bottom-up technique; cost was expressed as median cost per patient. Results 391 (male 288; 73.6%) patients were included. Their median age was 59 (range 49–69) years. The median time for hospitalization was 6 (range 5–11 days). The median inpatient cost was INR 1,86,564, with a wide range of (1,69,514 – 4,51,529); [USD 2743(2492–6640); € 2332(2118–5644)]. Surgical procedure with operation theatre contributed to 30% and was the highest among all the cost components. Consumables incurred (25%), bed charges (16%), anesthesia (8%), investigations (7%), drugs and professional fees of 6% each and miscellaneous charges (2%) contributed to the total cost. Conclusions The first pharmacoeconomic study for inpatients with CRC managed laparoscopically incurred modest cost. This study acts as a reference to future pharmacoeconomic studies in CRC. Its usefulness and advantages might lead to increased cost savings but needs justification by cost-benefit analysis in addition to long term outcome post-laparoscopic resection.