C J Young1,2, A Zahid1,2. 1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 2. University of Sydney, Sydney, New South Wales, Australia.
Abstract
AIM: In view of the increasing burden on the healthcare system, this study aims to perform a cost-effectiveness analysis of the management of incurable large bowel obstruction comparing the cost of a stent vs surgery. METHOD: A prospective randomized controlled trial was conducted at two major teaching hospitals in Australia between September 2006 and November 2011. Fifty-six patients with malignant incurable large bowel obstruction were randomized to stent insertion or surgical decompression, of whom 52 were included in the final analysis. Data were collected at all points during the patient journey and quality of life data were obtained by patient surveys. All data points were analysed and a cost-effectiveness study was performed to compare the costs between the two treatment groups. RESULTS: Stenting as a procedure was significantly more expensive than surgery (A$4462.50 vs A$3251.50; P < 0.001). Post-procedure stay for stented patients was significantly lower (median 7 vs 11 days; P = 0.03). Combined costs of stent group ward stay, multidisciplinary team discussion and complication management were significantly lower (P = 0.013). Overall cost difference between the two treatment groups was A$3902.44 (P = 0.101). European Quality of Life - 5 Dimensions (EQ-5D) scores for the first 4 weeks gave mean area under the curve adjusted weeks of 2.411 vs 2.271 for the stent and surgery groups respectively (P = 0.603). The incremental cost-effectiveness ratio between the surgery and the stent group was $22 955.53 in favour of stenting. CONCLUSIONS: Treatment with stenting is cheaper than open surgery and provides quicker discharge from hospital. Colorectal Disease
RCT Entities:
AIM: In view of the increasing burden on the healthcare system, this study aims to perform a cost-effectiveness analysis of the management of incurable large bowel obstruction comparing the cost of a stent vs surgery. METHOD: A prospective randomized controlled trial was conducted at two major teaching hospitals in Australia between September 2006 and November 2011. Fifty-six patients with malignant incurable large bowel obstruction were randomized to stent insertion or surgical decompression, of whom 52 were included in the final analysis. Data were collected at all points during the patient journey and quality of life data were obtained by patient surveys. All data points were analysed and a cost-effectiveness study was performed to compare the costs between the two treatment groups. RESULTS: Stenting as a procedure was significantly more expensive than surgery (A$4462.50 vs A$3251.50; P < 0.001). Post-procedure stay for stented patients was significantly lower (median 7 vs 11 days; P = 0.03). Combined costs of stent group ward stay, multidisciplinary team discussion and complication management were significantly lower (P = 0.013). Overall cost difference between the two treatment groups was A$3902.44 (P = 0.101). European Quality of Life - 5 Dimensions (EQ-5D) scores for the first 4 weeks gave mean area under the curve adjusted weeks of 2.411 vs 2.271 for the stent and surgery groups respectively (P = 0.603). The incremental cost-effectiveness ratio between the surgery and the stent group was $22 955.53 in favour of stenting. CONCLUSIONS: Treatment with stenting is cheaper than open surgery and provides quicker discharge from hospital. Colorectal Disease
Authors: Igor Braga Ribeiro; Wanderley Marques Bernardo; Bruno da Costa Martins; Diogo Touriani Hourneau de Moura; Elisa Ryoka Baba; Iatagan Rocha Josino; Nelson Tomio Miyahima; Martin Andrés Coronel Cordero; Thiago Arantes de Carvalho Visconti; Edson Ide; Paulo Sakai; Eduardo Guimarães Hourneau de Moura Journal: Endosc Int Open Date: 2018-05-08
Authors: Ainhoa Madariaga; Jenny Lau; Arunangshu Ghoshal; Tomasz Dzierżanowski; Philip Larkin; Jacek Sobocki; Andrew Dickman; Kate Furness; Rouhi Fazelzad; Gregory B Crawford; Stephanie Lheureux Journal: Support Care Cancer Date: 2022-03-10 Impact factor: 3.359