Journal Article

Cost comparison of gastrojejunostomy versus duodenal stent placement for malignant gastric outlet obstruction

Kuipers, E. J, Siersema, P. D, Jeurnink, S. M, Steyerberg, E. W, Polinder, S

2010

Overview

Background Gastrojejunostomy (GJJ) and stent placement are the most commonly used palliative treatments for malignant gastric outlet obstruction (GOO). In a recent randomized trial, stent placement was preferred in patients with a relatively short survival and GJJ in patients with a longer survival. As health economic aspects have only been studied in general terms, we estimated the cost of GJJ and that of stent placement in such patients. Methods In the SUSTENT study, patients were randomized to GJJ (n = 18) or stent placement (n = 21). Pancreatic cancer was the most common cause of GOO. We compared initial costs and costs during follow-up. For cost-effectiveness, the incremental cost-effectiveness ratio was calculated. Results Food intake improved more rapidly after stent placement than after GJJ, but long-term relief of obstructive symptoms was better after GJJ. More major complications (P = 0.02) occurred and more reinterventions were performed (P < 0.01) after stent placement than after GJJ. Initial costs were higher for GJJ compared to stent placement (€8315 vs. €4820, P < 0.001). We found no difference in follow-up costs. Total costs per patient were higher for GJJ compared to stent placement (€12433 vs. €8819, P = 0.049). The incremental cost-effectiveness ratio of GJJ compared to stent placement was €164 per extra day with a gastric outlet obstruction scoring system (GOOSS) ≥2 adjusted for survival. Conclusions Medical effects were better after GJJ, although GJJ had higher total costs. Since the cost difference between the two treatments was only small, cost should not play a predominant role when deciding on the type of treatment assigned to patients with malignant GOO (ISRCTN 06702358).

• Publisher: Japan : Springer Japan,Springer Japan,Springer,Springer Nature B.V
• Subject: Abdominal Surgery / Aged / Biliary Tract / Colorectal Surgery / Comparative analysis / complications / Cost-Benefit Analysis / Cost-effectiveness / Digestive System Neoplasms / Digestive System Neoplasms - complications / Digestive System Neoplasms - pathology / Digestive System Neoplasms - therapy / Duodenal stent placement / Duodenoscopy / Duodenoscopy - economics / Duodenum / Economic aspects / economics / etiology / Female / Gastric Bypass / Gastric Bypass - economics / Gastric Outlet Obstruction / Gastric Outlet Obstruction - economics / Gastric Outlet Obstruction - etiology / Gastric Outlet Obstruction - surgery / Gastroenterology / Gastrojejunostomy / Health Care Costs / Hepatology / Humans / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Original Article—Liver / Palliative Care / Palliative Care - economics / Pancreas / Pancreatic cancer / pathology / Quality of Life / Recurrence / Stent (Surgery) / Stents / Stents - economics / surgery / Surgical Oncology / therapy / Treatment Outcome