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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2020

Open Access 01-01-2020 | Rectal Cancer

Cost analysis in a randomized trial of early closure of a temporary ileostomy after rectal resection for cancer (EASY trial)

Authors: Jennifer Park, Eva Angenete, David Bock, Adiela Correa-Marinez, Anne K. Danielsen, Jacob Gehrman, Eva Haglind, Jens E. Jansen, Stefan Skullman, Anette Wedin, Jacob Rosenberg

Published in: Surgical Endoscopy | Issue 1/2020

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Abstract

Background

Hospital costs associated with the treatment of rectal cancer are considerable and the formation of a temporary stoma accounts for additional costs. Results from the EASY trial showed that early closure of a temporary ileostomy was associated with significantly fewer postoperative complications but no difference in health-related quality of life up to 12 months after rectal resection. The aim of the present study was to perform a cost analysis within the framework of the EASY trial.

Methods

Early closure (8–13 days) of a temporary stoma was compared to late closure (> 12 weeks) in the randomized controlled trial EASY (NCT01287637). The study period and follow-up was 12 months after rectal resection. Inclusion of participants was made after index surgery. Exclusion criteria were diabetes mellitus, steroid treatment, signs of postoperative complications or anastomotic leakage. Clinical effectiveness and resource use were derived from the trial and unit costs from Swedish sources. Costs were calculated for the year 2016 and analysed from the perspective of the healthcare sector.

Results

Fifty-five patients underwent early closure, and 57 late closure in eight Swedish and Danish hospitals between 2011 and 2014. The difference in mean cost per patient was 4060 US dollar (95% confidence interval 1121; 6999, p value < 0.01) in favour of early closure. A sensitivity analysis, taking protocol-driven examinations into account, resulted in an overall difference in mean cost per patient of $3608, in favour of early closure (95% confidence interval 668; 6549, p value 0.02). The predominant cost factors were reoperations, readmissions and endoscopic examinations.

Conclusions

The significant cost reduction in this study, together with results of safety and efficacy from the randomized controlled trial, supports the routine use of early closure of a temporary ileostomy after rectal resection for cancer in selected patients without signs of anastomotic leakage.

Clinical trial

Registered at clinicaltrials.gov, clinical trials identifier NCT01287637.
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Metadata
Title
Cost analysis in a randomized trial of early closure of a temporary ileostomy after rectal resection for cancer (EASY trial)
Authors
Jennifer Park
Eva Angenete
David Bock
Adiela Correa-Marinez
Anne K. Danielsen
Jacob Gehrman
Eva Haglind
Jens E. Jansen
Stefan Skullman
Anette Wedin
Jacob Rosenberg
Publication date
01-01-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06732-y

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