Cost analysis of laparoscopic and open liver resections in a DRG-based healthcare system
Huivaniuk I. 1,2, Zakharuk E. 1, Ivanykovych T. 2, Kopetskyi V.3,2, Kryzhevskyi V. 1, Prodashchuk A. 4, Topikha A. 3,2
- 1Kyiv Regional Cancer Center, Kyiv, Ukraine
- 2Global Medical Knowledge Alliance, Kyiv, Ukraine
- 3Nonprofit Organization National Cancer Institute, Kyiv, Ukraine
- 4National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Summary. Minimally invasive liver surgery is associated with improved perioperative outcomes, but its cost-effectiveness depends on the healthcare setting. In Ukraine, liver resections are reimbursed via a state-funded DRG system; however, evidence on the economic impact of laparoscopic approaches in a resource-constrained environment remains limited. Materials and methods. A retrospective analysis of a prospectively maintained database was performed from March 2024 to December 2025. A total of 124 liver resections were performed, including 54 laparoscopic procedures (43.5%). Two matched cohorts (20 patients each) were selected, excluding patients with major complications, and matched by resection type, comorbidities and perioperative course. Medication and consumable costs, length of stay, and complication rates were assessed; daily hospital costs were estimated from institutional data, excluding utilities. Results. Mean length of stay was 7 ± 2.5 days for open and 5 ± 1.6 days for laparoscopic procedures. Complication rates were 30% (open) and 15% (laparoscopic), all Clavien — Dindo grade I–II. Mean medication costs were 53 US dollars (USD) (open) and 45 USD (laparoscopic), while consumable costs were 820 USD and 1970 USD, respectively. Daily nutrition costs were 18 USD (hospital) and 13 USD (patient). Estimated staff costs included: physician salary 43 USD per day, nurse 64 USD and nursing assistance 45.5 USD per shift, operating room personnels 127 USD and anesthesiology 80 USD per case. NHSU reimbursement was 553 USD per case. Conclusion. Laparoscopic liver resection is associated with lower medication costs and shorter hospital stay. These benefits are offset by higher disposable costs, which may limit cost-effectiveness in DRG-based systems.
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