Plastic stents are more cost-effective than lumen-apposing metal stents in management of pancreatic pseudocysts

Abstract

Background and study aims Endoscopic ultrasound-guided drainage is an effective and accepted primary modality for management of pancreatic pseudocyst (PP). A lumen-apposing metal stent (LAMS) has recently been developed specifically for drainage of pancreatic fluid collections which may be superior to using traditional plastic stents (PS) but is more expensive. Because use of a stent involves a risk of unplanned endoscopy, percutaneous drainage (PCD) and surgery, their costs should also be included in the comparison and a cost-effectiveness analysis of LAMS and PS should therefore be performed Patients and methods A decision tree was developed assessing both endoscopic drainage strategies for patients with PP: LAMS and PS over a 6-month time horizon. For each strategy, inpatients received a stent and were followed for subsequent need for direct further interventions or adverse events leading to unplanned endoscopy, PCD, surgery, or successful endoscopic drainage using probabilities obtained from the literature. The unit of effectiveness was successful endoscopic drainage without need for PCD or surgery. Sensitivity analyses were performed. Results Success rates were 93.9 % for LAMS and 96.96 % for PS. Respective costs per successful drainage were US $ 18,129 (LAMS) and US $ 10,403 (PS). The LAMS strategy was thus characterized as dominated by the PS approach because it was costlier and less effective than PS. Both deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings. Conclusion Use of LAMS is not less effective and more costly than PS in management of patients with PP. As such, PS should be preferred over LAMS as initial management of these patients.

Prospective multicenter international study on the outcomes of a newly developed self‐approximating lumen‐apposing metallic stent for drainage of pancreatic fluid collections and endoscopic necrosectomy

“…In another study, the cost-effectiveness of PS versus LAMS in the management of pancreatic pseudocyst was assessed. 27 Success rates and costs for LAMS and PS were 93.9 % and 96.96 %, US $18 129 and $10 403, respectively. The study concluded that LAMS is not less effective but it is more costly than PS.…”

“…Adverse events and reinterventions were higher in the PS group (21.4% vs 0%, P = 0.521). In another study, the cost‐effectiveness of PS versus LAMS in the management of pancreatic pseudocyst was assessed . Success rates and costs for LAMS and PS were 93.9 % and 96.96 %, US $18 129 and $10 403, respectively.…”

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

“…As LAMS cannot be left indefinitely in situ , they must be exchanged for plastic stents in patients with disconnected ducts. Although LAMS are more expensive than plastic stents for the treatment of pseudocysts, given the need for multiple interventions and prolonged hospital stay in patients with WON, no difference has been observed in overall treatment costs between stent types . Table summarizes the key points of LAMS for treatment of PFC.…”

“…6 As LAMS cannot be left indefinitely in situ, they must be exchanged for plastic stents in patients with disconnected ducts. Although LAMS are more expensive than plastic stents for the treatment of pseudocysts, 7,8 given the need for multiple interventions and prolonged hospital stay in patients with WON, no difference has been observed in overall treatment costs between stent • Although retrospective studies report a higher clinical success rate for LAMS for the treatment of WON, 9 no such difference was observed in a recent randomized trial. 3 • Although no randomized trials have compared the efficacy of LAMS and plastic stents for pseudocyst drainage, in a retrospective comparative study of 205 patients, the rates of clinical success, adverse events and need for percutaneous drainage were found to be lower for LAMS.…”

Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis

“…Publication bias can arise from language bias, inflated estimates by a flawed methodological design in smaller studies, or a lack of publication of small trials with opposite results and so on, which were unable to estimate. Finally, two recent studies reported that LAMS was more costly in the management of PFC [40,41]. In our meta-analysis, we did not perform cost-effective analysis because such data were not commonly reported.…”