The cost effectiveness of self‐expanding metal stents in the management of malignant left‐sided large bowel obstruction

Osman, Osman; Rashid,; Sathananthan,; Parker,

doi:10.1046/j.1463-1318.2000.00140.x

Cited by 66 publications

(41 citation statements)

References 12 publications

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“…Though the cost associated with colonic stenting is higher than the cost of performing a diverting colostomy for the initial management of acute, malignant colonic obstruction, the incremental cost associated with providing one additional improved patient outcome is very reasonable. Previously published cost-effectiveness analyses (17,25) have revealed results similar to our findings in the present study. In one analysis (25) performed using United Kingdom health care costs, preoperative colonic stenting resulted in a mean net savings of £685 per stented patient compared with performance of the Hartmann's procedure, mainly due to a shorter length of hospital stay for stented patients.…”

Section: Discussionsupporting

confidence: 92%

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

Singh

Latosinsky

Spiegel

et al. 2006

Canadian Journal of Gastroenterology

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The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: A Canadian perspective. Can J Gastroenterol 2006;20(12):779-785.BACKGROUND: Over the past several years, colonic stenting has been advocated as an alternative to the traditional surgical approach for relieving acute malignant left-sided colonic obstruction. The aim of the present study was to determine the most cost-effective strategy in a Canadian setting. PATIENTS AND METHODS: A decision analytical model was developed to compare three competing strategies: CS -emergent colonic stenting followed by elective resective surgery and reanastomosis; RS -emergent resective surgery followed by creation of either a diverting colostomy or primary reanastomosis; and DC -emergent diverting colostomy followed by elective resective surgery and reanastomosis. The costs were estimated from the perspective of the Manitoba provincial health plan. RESULTS: The use of CS resulted in fewer total operative procedures per patient (mean CS 1.03, RS 1.32, DC 1.9), lower mortality rate (CS 5%, RS 11%, DC 13%) and lower likelihood of requiring a permanent stoma (CS 7%, RS 14%, DC 14%). CS is slightly more expensive than DC, but less costly than RS (DC $11,851, CS $13,164, RS $13,820). The incremental cost-effectiveness ratio associated with the use of CS versus DC is $1,415 to prevent a temporary stoma, $1,516 to prevent an additional operation and $15,734 to prevent an additional death. CONCLUSIONS: Colonic stenting for patients with acute colonic obstruction secondary to a resectable colonic tumour is comparable in cost with surgical options, and reduces the likelihood of requiring both temporary and permanent stomas. Colonic stenting should be offered as the initial therapeutic modality for Canadian colorectal cancer patients presenting with acute obstruction as a bridge to definitive RS.

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Section: Discussionsupporting

confidence: 92%

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

Singh

Latosinsky

Spiegel

et al. 2006

Canadian Journal of Gastroenterology

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“…6,11 In addition, this procedure may shorten the length of hospital stay and be more cost-effective than surgeries. 6,[16][17][18] In contrast to colorectal cancers, in which the obstructions develop from intraluminal growth, obstructions by metastatic or invasive noncolorectal cancer develop from extrinsic compression. Because obstruction and tumor characteristics differ between colorectal cancer and extrinsic tumor-related obstruction, the results of SEMS insertion are expected to be different.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of Self-Expandable Metallic Stent for Treatment of Colorectal Obstruction Caused by Extrinsic Invasive Tumors

Shin

Kim

et al. 2008

Diseases of the Colon &Amp; Rectum

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“…A small retrospective study from the UK in 1998 showed that the mean net saving from palliative stenting compared to surgical decompression was £1769, whereas the saving from stenting as a bridge to surgery followed by elective resection, compared to emergency Hartmann's operation followed by elective reversal was £685. 42 A RCT from Greece comparing stenting and colostomy for palliation of patients with inoperable malignant partial colonic obstruction showed very small difference in the costs, with the stent group being 6.9% (132 euros) more expensive per patient. 32 Another study from Switzerland reported stenting to be 19.7% less costly than surgery.…”

Section: Colonic Stentsmentioning

confidence: 99%

Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

Trompetas

2008

annals

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The searches showed one Cochrane systematic review, two further systematic reviews, one meta-analysis, two decision METHODS A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. DISCUSSION Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure.

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The cost effectiveness of self‐expanding metal stents in the management of malignant left‐sided large bowel obstruction

Abstract: Stenting of acute large bowel obstruction is a cost-effective procedure with a reduction in total hospital stay and expenditure compared with surgical decompression.

Cited by 66 publications

References 12 publications

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

Clinical Application of Self-Expandable Metallic Stent for Treatment of Colorectal Obstruction Caused by Extrinsic Invasive Tumors

Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

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