Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer

Abstract

Self-expanding metal stent placement and single-dose brachytherapy are commonly used for the palliation of oesophageal obstruction due to inoperable oesophagogastric cancer. We randomised 209 patients to the placement of an Ultraflex stent (n ¼ 108) or single-dose brachytherapy (12 Gy, n ¼ 101). Cost comparisons included comprehensive data of hospital costs, diagnostic interventions and extramural care. We acquired detailed information on health care consumption from a case record form and from monthly home visits by a specialised nurse. The initial costs of stent placement were higher than the costs of brachytherapy (h1500 vs h570; Po0.001). Total medical costs were, however, similar (stent h11 195 vs brachytherapy h10 078, P40.20). Total hospital stay during follow-up was 11.5 days after stent placement vs 12.4 days after brachytherapy, which was responsible for the high intramural costs in both treatment groups (stent h6512 vs brachytherapy h7982, P40.20). Costs for medical procedures during follow-up were higher after stent placement (stent h249 vs brachytherapy h168, P ¼ 0.002), while the costs of extramural care were similar (h1278 vs h1046, P40.20). In conclusion, there are only small differences between the total medical costs of both palliative treatment modalities, despite the fact that the initial costs of stent placement are much higher than those of brachytherapy. Therefore, cost considerations should not play an important role in decision making on the appropriate palliative treatment strategy for patients with malignant dysphagia. The incidence of oesophageal cancer has risen rapidly, due to a marked increase in the incidence of adenocarcinoma (Devesa et al, 1998;Botterweck et al, 2000). Oesophageal cancer is a disease with a high mortality, as reflected by a 5-year survival of 10 -15% (Pisani et al, 1999). Moreover, more than 50% of patients with oesophageal cancer have already inoperable disease at presentation. Most of these patients require palliative treatment to relieve progressive dysphagia (Sagar et al, 1994). Treatment options presently available for palliation of dysphagia include selfexpanding metal stent placement (Kozarek et al, 1996;Bartelsman et al, 2000;Siersema et al, 2001), laser therapy (Dallal et al, 2001), photodynamic therapy (PDT) (Luketich et al, 2000;Moghissi et al, 2000), external beam radiation in combination with brachytherapy (Taal et al, 1996;Schraube et al, 1997), brachytherapy as a sole treatment (Jager et al, 1995;Sur et al, 2002; Homs et al, 2003a) and dilatation (Lundell et al, 1989). A disadvantage of laser therapy is that repeated treatment sessions are required to achieve and maintain adequate palliation (Dallal et al, 2001;Spencer et al, 2002). A combined treatment of external beam radiation with brachytherapy is often too intensive for patients with inoperable disease due to metastases or a poor medical condition. Photodynamic therapy involves the local destruction of tumour tissue by light of a specific wavelength activating a previously administered photo...

A systematic review of studies measuring health-related quality of life of general injury populations

“…We used two primary data sources: 1) hospital discharge registers (HDR) with full national coverage to estimate the hospitalization rate and 2) emergency-department (ED) surveillance systems for the incidence of non-admitted ED patients[10,11]. Since ED systems did not have nationwide coverage, country-specific extrapolation factors were used to extrapolate the ED incidence towards national level for the respective types of injury by country[7,11]. We computed YLL using a standard life table[5,12].…”

Oesophageal stenting

“…The cost of stenting with that of single-dose brachytherapy has been prospectively compared by polinder et al [118]. They demonstrated that the cost of each treatment is similar.…”

Cost-Effectiveness of Palliation of Unresectable Esophageal Cancer

“…This study was performed alongside a cohort of patients with unresectable EC, but the short follow-up (2 months) probably failed to capture most of the adverse events associated with the palliative treatments under evaluation. Polinder et al performed a cost-analysis on a large randomized trial comparing esophageal metal stent to single dose brachytherapy [31]. While procedure-related costs were higher in the stent group, post-treatment care was more expensive in patients managed with brachytherapy, which accounted for similar total costs.…”