One-year health care expenditures and patient out-of-pocket spending after open versus minimally invasive hepatopancreatobiliary surgery.

Abstract

Minimally invasive surgery is increasingly adopted for hepatopancreatobiliary procedures; however, expenditure data beyond the index hospitalization remain limited, and the patient out-of-pocket burden remains unclear. We compared 1-year health care expenditures, out-of-pocket spending, utilization, and missed workdays after open versus minimally invasive hepatopancreatobiliary surgery. Adults who underwent hepatectomy or pancreatectomy were identified from the IBM MarketScan Commercial Claims and Encounters database (2016-2023). Inverse probability of treatment weighting with a doubly robust specification was used to compare open versus minimally invasive surgery. Among 4,552 patients, 26.1% (N = 1,188) underwent minimally invasive surgery. Minimally invasive surgery was associated with shorter length of stay (-2.6 days; 95% confidence interval, -3.1 to -2.1), lower odds of 30-day readmission (odds ratio, 0.71; 95% confidence interval, 0.58-0.88), lower 1-year total expenditures (-$33,255; 95% confidence interval, -$46,582 to -$20,789), and fewer total missed workdays (-6.5 days; 95% confidence interval, -8.4 to -4.6). Aggregate patient out-of-pocket spending was not measurably different (+$95; 95% confidence interval, -$691 to $1,040; P = .827), whereas insurer payments were lower (-$33,627; 95% confidence interval, -$48,365 to -$21,593) following minimally invasive surgery. An interaction was observed between out-of-pocket spending and plan type (P = .019). Minimally invasive surgery was associated with lower out-of-pocket costs in more restrictive plans but not in less restrictive plans. Findings were consistent across sensitivity analyses. Minimally invasive hepatopancreatobiliary surgery was associated with lower 1-year expenditures, shorter hospitalization, fewer readmissions, and fewer encounter-derived missed workdays compared with open surgery, although cost reductions varied by procedure subtype. Aggregate patient out-of-pocket spending on covered services was not measurably lower overall, suggesting that payer-level savings do not uniformly translate into lower patient cost sharing.