Cost analysis of pulmonary lobectomy procedure: comparison of stapler versus precision dissection and sealant

Andrea Droghetti,1 Giuseppe Marulli,2 Jacopo Vannucci,3 Michele Giovanardi,1 Maria Caterina Bottoli,1 Mark Ragusa,3 Giovanni Muriana1 1Thoracic Surgery Division, Carlo Poma Hospital, Mantova, 2Thoracic Surgery Division, University of Padova, Padova, 3Thoracic Surgery Division, University of Perugia, Perugia, Italy Objective: We aimed to evaluate the direct costs of pulmonary lobectomy hospitalization, comparing surgical techniques for the division of interlobar fissures: stapler (ST) versus electrocautery and hemostatic sealant patch (ES). Methods: The cost comparison analysis was based on the clinical pathway and drawn up by collecting the information available from the Thoracic Surgery Division medical team at Mantova Hospital. Direct resource consumption was derived from a previous randomized controlled trial including 40 patients. Use and maintenance of technology, equipment and operating room; administrative plus general costs; and 30-day use of postsurgery hospital resources were considered. The analysis was conducted from the hospital perspective. Results: On the average, a patient submitted to pulmonary lobectomy costs €9,744.29. This sum could vary from €9,027 (using ES) to €10,460 (using ST). The overall lower incidence (50% vs 95%, P=0.0001) and duration of air leakage (1.7 days vs 4.5 days, P=0.0001) in the ES group significantly affects the mean time of hospital stay (11.0 days vs 14.3 days) and costs. Cost saving in the ES group was also driven by the lower incidence of complications. The main key cost driver was staff employment (42%), then consumables (34%) and operating room costs (12%). Conclusion: There is an overall saving of around €1,432.90 when using ES patch for each pulmonary lobectomy. Among patients undergoing this surgical procedure, ES can significantly reduce air leakage incidence and duration, as well as decrease hospitalization rates. However, further multicenter research should be developed considering different clinical and managerial settings. Keywords: pulmonary lobectomy, hemostatic sealant patch, TachoSil®, economic evaluation, cost analysis