Objective: To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources. Methods: By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0. Results: A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference (MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased (MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery (MD=-33 000.00 yuan) with no significant difference (P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery (MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased (MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery (P<0.001). Conclusions: In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.
目的： 与传统开放手术对比，分析微创手术治疗食管癌、胃癌、结直肠癌的卫生经济学评价的现状，为临床合理选择治疗术式、缓解疾病经济负担、合理分配卫生资源提供重要依据。 方法： 检索中国知网、万方数据知识服务平台、中国生物医学文献、PubMed、Embase自建库至2023年12月31日所有关于微创手术治疗食管癌、胃癌、结直肠癌的卫生经济学研究的文献。采用NoteExpress 3.8软件整理文献，通过Excel 2021软件对数据进行汇总，采用CHEERS 2022清单对纳入文献的报告质量进行评估，采用Stata 17.0软件进行Meta分析。 结果： 共检索到相关领域文献10 919篇，最终筛选出符合纳入排除标准的研究59项，仅14项（23.7%）使用了标准的卫生经济学评价方法。Meta分析结果显示，微创手术和开放手术的直接医疗成本、总成本差异无统计学意义，微创手术的手术费用显著增加［均数差（MD）=5 973.12元，P<0.001］，住院时间和间接成本明显降低（MD值分别为-4.85 d、-733.79元，P<0.001）。国内胃癌的直接医疗成本，内镜下手术低于开放手术（MD=-33 000.00元，P<0.001），腹腔镜手术与开放手术之间差异无统计学意义；结直肠癌腹腔镜手术直接医疗成本、手术费用均高于开放手术（MD值分别为4 277.94元、4 267.80元，P<0.001），间接成本和总成本降低（MD值分别为-768.34元、-159.10元）；3种癌症患者行微创手术的住院时间均短于开放手术（P<0.001）。 结论： 消化道癌的微创手术与开放手术相比，虽然手术费用增加，但具有住院时间短、间接成本低等优势，且两者直接医疗成本和总成本差异无统计学意义。进行卫生经济学评价应综合考虑术后并发症、住院时间、患者经济差异等对总成本的影响，重视卫生经济学评价在卫生决策中的应用。.