Laparoscopic myomectomy may save $300/case

OB/GYN News,  Feb 15, 2002  by Erik L. Goldman

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NEW YORK -- Insurance carriers and government health care payers in New Jersey often claim that laparoscopic myomectomy costs them more than traditional open procedures, and therefore should not be encouraged. Dr. George Tweddel and Dr. Gerard Pregenzer beg to differ.

The pair of Somerset, N.J., laparoscopic surgeons crunched the comparative cost data on 52 of their own patients undergoing either open or laparoscopic myomectomy, and found that the scope-based procedure came up the winner, saving about $300 per case. They presented their findings at an international congress sponsored by the Society of Laparoendoscopic Surgeons.

"We were wondering why advanced laparoscopic cases requiring advanced skill levels were being reimbursed at the same or lower rates than simple, open procedures," Dr. Tweddel said. "We started asking payers, and they said laparoscopy was expensive, or added costs to the procedure. This just didn't make sense. Why would a same-day procedure cost more than one requiring a hospital stay?"

The concern was more than academic. It is their contention that poor reimbursement has forced many of their New Jersey colleagues to abandon laparoscopic myomectomy altogether. "Managed care discourages us from doing it. In our county, only about 5% of gynecologic surgeons are doing laparoscopy, when we all know that the best thing for many of these patients is to do it," Dr. Pregenzer said.

They decided to look to their own case records to see if the payers' position was valid. The study included patients matched for pathology, number, and weight of fibroids removed, who underwent myomectomy over a 3-year period. There were 25 patients in the laparotomy group and 27 in the laparoscopy group.

Laparoscopic myomectomies were done with bipolar cauterization--and morcellation if needed. Vasopressin was used on patients if the lesions were deep in the myometrium.

Open procedures had a lower average operating time of 2 hours, versus 3.25 hours for the laparoscopic procedures. However, the figure for the laparoscopic group was somewhat skewed by one particular case in which a 5-mm myoma screw displaced during the procedure had to be retrieved. The operating time in that case was 7 hours, far in excess of the 2- to 3-hour average for the remaining laparoscopic cases.

All the laparoscopic patients were discharged within 8 hours of admission, whereas the average for open surgical cases was 1 full day, including an overnight stay.

The total average cost for an open myomectomy was $4,610; for laparoscopic procedure it was $4,317.50--a cost savings of just under $300. The cost of laparoscopy was even less if the procedure could be done without the morcellator, which can add about $400 in time and equipment costs to a procedure.

Dr. Tweddel said intraoperative blood loss was equivalent in the two groups, and there were no conversions of laparoscopic procedures to open ones. There were no major clinical differences in outcome between the two groups, and no need for reoperation.

Not surprisingly, patients who underwent the laparoscopic procedures returned to normal activity sooner and had far less scarring.

Contrary to the position taken by managed care companies, Medicare, and Medicaid, the investigators believe the laparoscopic approach should be the first-choice standard for those patients with fibroids.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning