LAPAROSCOPIC APPENDECTOMY IN THAILAND: COST GAP ANALYSIS AND POLICY IMPLICATIONS voranaddha.vac@chulahospital.org

 

LAPAROSCOPIC APPENDECTOMY IN THAILAND: COST GAP ANALYSIS AND POLICY IMPLICATIONS

5

Thailand

Oral or Poster

Laparoscopic appendectomy (LA) has replaced open appendectomy (OA) as the standard of care in many countries due to reduced postoperative pain, lower surgical site infection (SSI) rates, and shorter hospital length of stay (LOS). In high-income settings, higher operative costs are offset by LOS-related savings. In Thailand, however, LA adoption is limited by a “donut hole” reimbursement gap under the National Health Security Office (NHSO) universal coverage scheme, where excess is absorbed by either hospital or patient.

We conducted a retrospective cohort study of adults (≥18 years) undergoing appendectomy for acute appendicitis from January 2022-June 2024 at a tertiary Red Cross public hospital in Bangkok. Pregnant patients, delayed/interval appendectomy, or concomitant procedures were excluded. Costs were calculated using activity-based costing in two scenarios: current practice (disposable items resterilized up to five times) and a standardized, economical laparoscopic tray (ST) with metallic resterilizable instruments. LOS and costs were modeled using multivariable regression adjusted for demographic and clinical covariates.

Of 428 patients, 83 (19.4%) underwent LA and 345 (80.6%) OA. LA reduced LOS by 21% (adjusted IRR 0.79; 95% CI 0.67–0.93). Clinical outcomes were similar. Incremental cost per inpatient day saved was USD1,076 for current practice and USD743 with ST-both far exceeding the local ward-day cost of USD80-100. The reimbursement-to-charge ratio (R/C) across payers was 0.36–0.75; under NHSO, R/C was 0.42 for OA and 0.33 for LA.

Even with ST, the reimbursement gap makes universal LA adoption financially challenging. Targeted policy changes for patients most likely to benefit from LA is warranted.