I. Lareef1, S. Wong1,2 2Dartmouth Hitchcock,Department Of Surgery,Lebanon, NH, USA 1Geisel School of Medicine at Dartmouth,Hanover, NH, USA
Introduction:
Minimally invasive hepatopancreaticobiliary (HPB) surgery has heralded economic advantages such as reduced length of stay and this must be balanced with increased device and intraoperative costs. Therefore, the literature assessing cost effectiveness has proliferated. Reporting quality in health economics literature is variable due to the broad nature of such evaluations. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guideline was created to improve the quality of reporting in health economics literature, and we used it to assess the HPB literature.
Methods:
A systematic review of PubMed, Web Of Science, Science Direct, and EconLit was conducted to identify articles that evaluated economic outcomes for robotic or laparoscopic oncologic HPB procedures. 2458 abstracts were reviewed and subject to the following exclusion criteria: non-peer reviewed, non-original source data (though reference lists of systematic reviews were checked), non-English language articles, no cost data reported, and non-cancer resections. A full text review of the remaining 98 articles excluded laparoscopic cholecystectomy and operations performed with non-curative intent.
Results:
A total of 44 articles were assessed for adherence to a total of 27 CHEERS checklist criteria, which are divided into the following sections: “Title and Abstract”, “Introduction”, “Methods”, “Results”, “Discussion”, and “Other”(2, 1, 16, 5, 1, and 2 items, respectively).
20/44 (45.5%) articles reported that minimally invasive surgery was more cost effective compared to the open approach, 9/44 (20.5%) reported lower cost effectiveness (higher costs), 14/44 (31.8%) reported no difference, and 1/44 (2.3%) article did not report any comparative data. The average number of total criteria met was 14.5 out of 27. Adherence to the criteria was highly variable (range 7-22). The least adhered to criteria were the inclusion of effectiveness measurement methodology and the elicitation of outcome preferences from patients. The most adhered to criteria were the inclusion of an abstract, background, objectives, and discussion. None of the articles met all of the CHEERS criteria; in fact, 21/44 (47%) did not even meet 50% of the checklist criteria. Furthermore, the average number of Methods criteria, indicative of a robust cost effectiveness evaluation, that were met was less than half of the total (7.2/16 criteria).
Conclusion:
The reporting quality around the cost effectiveness of minimally invasive HPB surgery can be improved. We found that most of these articles that claim to be cost effectiveness evaluations are, in reality, cost reporting studies. Greater adherence to CHEERS, specifically its Methods section, would improve reporting quality, as would accuracy around the classification of reporting type. Alternatively, the CHEERS criteria may be too rigid and not reflective of the quality of economic studies.