The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective.

BACKGROUND: Over the past several years, colonic stenting has been advocated as an alternative to the traditional surgical approach for relieving acute malignant left-sided colonic obstruction. The aim of the present study was to determine the most cost-effective strategy in a Canadian setting. patients and
METHODS: A decision analytical model was developed to compare three competing strategies: CS - emergent colonic stenting followed by elective resective surgery and reanastomosis; RS - emergent resective surgery followed by creation of either a diverting colostomy or primary reanastomosis; and DC - emergent diverting colostomy followed by elective resective surgery and reanastomosis. The costs were estimated from the perspective of the Manitoba provincial health plan.
RESULTS: The use of CS resulted in fewer total operative procedures per patient (mean CS 1.03, RS 1.32, DC 1.9), lower mortality rate (CS 5%, RS 11%, DC 13%) and lower likelihood of requiring a permanent stoma (CS 7%, RS 14%, DC 14%). CS is slightly more expensive than DC, but less costly than RS (DC 11,851 dollars, CS 13,164 dollars, RS 13,820 dollars). The incremental cost-effectiveness ratio associated with the use of CS versus DC is 1,415 dollars to prevent a temporary stoma, 1,516 dollars to prevent an additional operation and 15,734 dollars to prevent an additional death.
CONCLUSIONS: Colonic stenting for patients with acute colonic obstruction secondary to a resectable colonic tumour is comparable in cost with surgical options, and reduces the likelihood of requiring both temporary and permanent stomas. Colonic stenting should be offered as the initial therapeutic modality for Canadian colorectal cancer patients presenting with acute obstruction as a bridge to definitive RS.