Cost analysis of a long‐term randomized controlled study in biliary duct‐to‐duct anastomotic stricture after liver transplantation. (1st April 2021)

• Record Type: Journal Article
• Authors: Cantù, Paolo; Santi, Giulio; Rosa, Roberto; Parzanese, Ilaria; Macchini, Federico; Tenca, Andrea; Fanetti, Ilaria; Invernizzi, Federica; Donato, Maria Francesca; Lampertico, Pietro; Reggiani, Paolo; Rossi, Giorgio; Vecchi, Maurizio; Penagini, Roberto
• Is Part Of: Transplant international. Volume 34:Number 5(2021)
• Page Start: 825
• Page End: 834
• Publication Date: 2021-04-01
• Subjects: biliary anastomotic stricture -- endoscopic retrograde cholangiopancreatography procedure -- liver transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13867
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Multiple plastic stent (MPS) for biliary anastomotic stricture (AS) after liver transplantation requires multiple procedures with consequent costs. To compare the success, adverse events and treatment‐related costs of fully covered self‐expandable metal stents (FCSEMS) versus MPS. Thirty liver transplant (LT) patients with clinically relevant naïve AS were prospectively randomized to FCSEMS or MPS, with stent numbers increased at 3‐month intervals. Treatment costs per patient were calculated for endoscopic retrograde cholangiopancreatography (including all devices and stents) and overall hospital stay. Radiological success was achieved in 73% of FCSEMS (median indwelling period of 6 mos) and 93% of MPS patients ( P = NS) (median period of 11 mos). AS recurrence occurred in 36% of FCSEMS and 7% of MPS patients ( P = NS), and AS re‐treatment was needed in 53% and 13% ( P < 0.01), respectively, during follow‐up of 60 (34–80) months. Stents migrated after 29% and 2.6% of FCSEMS and MPS procedures, respectively ( P < 0.01). Including re‐treatments, long‐term clinical success was achieved in 28/30 (93%) patients. Overall treatment‐related costs were similar between groups. In the subgroup of LT patients in clinical remission after first‐line treatment, treatment costs were 41% lower per FCSEMS patient compared with MPS patients. FCSEMS did not perform better than MPS. FCSEMS migration increased the rate of re‐treatment and costs.