Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil

ABSTRACT Introduction: this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2017 to 2020 at a hospital with specialties besides the basic ones in southern Brazil. Methods: the study sample included 26 participants. The first 13 laparotomies, and the first 13 laparoscopies performed at the bariatric surgery service of the institution were evaluated. The values evaluated in such comparison analyzed the costs of operation and hospitalization. It is important to highlight that, in addition to the cost benefit, other costs take significance in the health area, such as: cost-utility, cost-effectiveness and cost-minimization, in addition to the cost-opportunity that is reassessed in the observation of the broad context associating all the values raised here. The software used for data analysis was Excel version® 365. The economic analysis was performed evidencing the profile of the patients and the direct and indirect costs involved in each segmentation. Results: the direct and indirect costs of videolaparoscopy amounted to BRL 10,108.10 and laparoscopy to the amount of BRL 12,568.14. Conclusion: it was concluded that laparoscopy presents more savings in the aspects of all health valuations to the detriment of laparotomy. It was concluded that the videolaparoscopy presents more savings in the aspects of all health valuations than the laparotomy.

摘要
引言：本研究旨在通过临床-经济学回顾性横断面分析（clinical-economical retrospective and cross-sectional analysis），评估巴西南部一家除基础科室外设有专科的医院2017至2020年间，减重外科手术（bariatric surgeries）中首次开腹术（laparotomy）与腹腔镜术（laparoscopy）的主要直接及间接成本。
方法：本研究样本共纳入26例研究对象，分别对该机构减重外科开展的前13例开腹术与前13例腹腔镜术进行评估。本次对比分析的指标为手术及住院成本。需特别说明的是，除成本效益外，卫生领域还有其他具有重要意义的成本分析维度，包括成本效用（cost-utility）、成本效果（cost-effectiveness）与成本最小化（cost-minimization），此外还需结合本次研究获取的全部数据，在宏观背景下重新评估机会成本（cost-opportunity）。本研究采用Excel® 365版本软件进行数据分析，通过经济分析明确患者特征及各分组涉及的直接与间接成本。
结果：电视腹腔镜术（videolaparoscopy）的直接及间接成本为10108.10巴西雷亚尔（BRL），开腹术的直接及间接成本为12568.14巴西雷亚尔（BRL）。
结论：本研究认为，相较于开腹术，腹腔镜术在各项卫生价值评估维度中均更具成本节约优势。本研究同时认为，电视腹腔镜术在各项卫生价值评估维度中均优于开腹术，可实现更多成本节约。