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Surgical Endoscopy

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01-05-2021 | Colorectal Cancer

Cost-effectiveness of palliative emergent surgery versus endoscopic stenting for acute malignant colonic obstruction

Authors: Patrick L. Quinn, Simran Arjani, Sushil K. Ahlawat, Ravi J. Chokshi

Published in: Surgical Endoscopy | Issue 5/2021

Abstract

Background

Endoscopic stenting has demonstrated value over emergent surgery as a palliative intervention for patients with acute large bowel obstruction due to advanced colorectal cancer. However, concerns regarding high reintervention rates and the risk of perforation have brought into question its cost-effectiveness.

Methods

A decision tree analysis was performed to analyze costs and survival in patients with unresectable or metastatic colorectal cancer who present with acute large bowel obstruction. The model was designed with two treatment arms: self-expanding metallic stent (SEMS) placement and emergent surgery. Costs were derived from medicare reimbursement rates (US$), while effectiveness was represented by quality-adjusted life years (QALYs). The primary outcome measure was the incremental cost-effectiveness ratio (ICER). The model was tested for validation using one-way, two-way, and probabilistic sensitivity analyses.

Results

Endoscopic stenting resulted in an average cost of $43,798.06 and 0.68 QALYs. Emergent surgery cost $5865.30 more, while only yielding 0.58 QALYs. This resulted in an ICER of − $58,653.00, indicating that SEMS placement is the dominant strategy. One-way and two-way sensitivity analyses demonstrated that emergent surgery would require an improved survival rate in comparison to endoscopic stenting to become the favored treatment modality. In 100,000 probabilistic simulations, endoscopic stenting was favored 96.3% of the time.

Conclusions

In patients with acute colonic obstruction in the presence of unresectable or metastatic disease, endoscopic stenting is a more cost-effective palliative intervention than emergent surgery. This recommendation would favor surgery over SEMS placement with improved surgical survival, or if the majority of patients undergoing stenting required reintervention.

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Title: Cost-effectiveness of palliative emergent surgery versus endoscopic stenting for acute malignant colonic obstruction
Authors: Patrick L. Quinn
Simran Arjani
Sushil K. Ahlawat
Ravi J. Chokshi
Publication date: 01-05-2021
Publisher: Springer US
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: Surgical Endoscopy / Issue 5/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07637-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost-effectiveness of palliative emergent surgery versus endoscopic stenting for acute malignant colonic obstruction

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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