Indirect Costs

While the direct costs associated with laparoscopy are easiest to evaluate, the indirect cost advantages of laparoscopy should not be overlooked. Many patients who require urologic procedures are productive participants in the national economy. So, loss of global revenue due to loss of work impacts the entire health-care system. The earlier return to work that has been demonstrated for numerous laparoscopic procedures should not be overlooked. Dunn et al. reported a 4.5-week quicker return to normal activity for laparoscopic nephrectomy patients compared with a matched series of open nephrectomy patients (1). Buell et al. noted that patients after hand-assisted donor nephrectomy returned to work 25 days earlier than after open donor nephrec-tomy (29.1 days vs. 54.3 days; p < 0.05, respectively). Bhayani et al. found that time to complete convalescence was 30 days versus 47 days after laparoscopic radical prostatectomy and radical retropubic prostatectomy, respectively (25). Similar findings were found by Rassweiler et al. with a convalescence time of 27 days versus 52 days after laparoscopic radical prostatectomy and radical retropubic prostatectomy, respectively (19). As such, patients after laparoscopic procedures routinely return to work earlier and contribute to the national economy. According to the 2001 Census of Population and Housing from the United States Census Bureau, the average American worker earned approximately $141 per day in 2000 dollars. So, a 15-day difference in return to work has a value to society of $2115, which would clearly eliminate the incremental cost of most laparoscopic procedures.

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