Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy. Issue 1 (24th January 2023)
- Record Type:
- Journal Article
- Title:
- Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy. Issue 1 (24th January 2023)
- Main Title:
- Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy
- Authors:
- Highet, Alexandra
Johnson, Emily H.
Bonham, Aaron J.
Hutton, David W.
Zhou, Shuhao
Thalji, Ameen S.
Ghaferi, Amir A. - Abstract:
- Abstract : Objective: To perform a cost-effectiveness analysis of staple-line reinforcement in laparoscopic sleeve gastrectomy. Summary of Background Data: Exponential increases in surgical costs have underscored the critical need for evidence-based methods to determine the relative value of surgical devices. One such device is staple-line reinforcement, thought to decrease bleeding rates in laparoscopic sleeve gastrectomy. Methods: Two intervention arms were modeled, staple-line reinforcement and standard nonreinforced stapling. Bleed and leak rates and 30-day treatment costs were obtained from national and state registries. Quality-adjusted life-year (QALY) values were drawn from previous literature. Device prices were drawn from institutional data. A final incremental cost-effectiveness ratio was calculated, and one-way and probabilistic sensitivity analyses were performed. Results: A total of 346, 530 patient records from 2012 to 2018 were included. Complication rates for the reinforced and standard cohorts were 0.05% for major bleed in both cohorts ( P = 0.8841); 0.45% compared with 0.59% for minor bleed ( P < 0.0001); and 0.24% compared with 0.26% for leak ( P = 0.4812). Median cost for a major bleed was $5552 ($3287, $16, 817) and $2406 ($1861, $3484) for a minor bleed. Median leak cost was $9897 ($4589, $21, 619) and median cost for patients who did not experience a bleed, leak, or other serious complication was $1908 ($1712, $2739). Mean incremental cost ofAbstract : Objective: To perform a cost-effectiveness analysis of staple-line reinforcement in laparoscopic sleeve gastrectomy. Summary of Background Data: Exponential increases in surgical costs have underscored the critical need for evidence-based methods to determine the relative value of surgical devices. One such device is staple-line reinforcement, thought to decrease bleeding rates in laparoscopic sleeve gastrectomy. Methods: Two intervention arms were modeled, staple-line reinforcement and standard nonreinforced stapling. Bleed and leak rates and 30-day treatment costs were obtained from national and state registries. Quality-adjusted life-year (QALY) values were drawn from previous literature. Device prices were drawn from institutional data. A final incremental cost-effectiveness ratio was calculated, and one-way and probabilistic sensitivity analyses were performed. Results: A total of 346, 530 patient records from 2012 to 2018 were included. Complication rates for the reinforced and standard cohorts were 0.05% for major bleed in both cohorts ( P = 0.8841); 0.45% compared with 0.59% for minor bleed ( P < 0.0001); and 0.24% compared with 0.26% for leak ( P = 0.4812). Median cost for a major bleed was $5552 ($3287, $16, 817) and $2406 ($1861, $3484) for a minor bleed. Median leak cost was $9897 ($4589, $21, 619) and median cost for patients who did not experience a bleed, leak, or other serious complication was $1908 ($1712, $2739). Mean incremental cost of reinforced stapling compared with standard was $819.60/surgery. Net QALY gain with reinforced stapling compared with standard was 0.00002. The resultant incremental cost-effectiveness ratio was $40, 553, 000/QALY. One-way and probabilistic sensitivity analyses failed to produce a value below $150, 000/QALY. Conclusions: Compared with standard stapling, reinforced stapling reduces minor postoperative bleeding but not major bleeding or leaks and is not cost-effective if routinely used in laparoscopic sleeve gastrectomy. … (more)
- Is Part Of:
- Annals of surgery. Volume 277:Issue 1(2023)
- Journal:
- Annals of surgery
- Issue:
- Volume 277:Issue 1(2023)
- Issue Display:
- Volume 277, Issue 1 (2023)
- Year:
- 2023
- Volume:
- 277
- Issue:
- 1
- Issue Sort Value:
- 2023-0277-0001-0000
- Page Start:
- 121
- Page End:
- 126
- Publication Date:
- 2023-01-24
- Subjects:
- bariatric surgery -- cost-effectiveness analysis -- staple-line reinforcement
Surgery -- Periodicals
617.005 - Journal URLs:
- http://www.annalsofsurgery.com ↗
http://journals.lww.com ↗ - DOI:
- 10.1097/SLA.0000000000004950 ↗
- Languages:
- English
- ISSNs:
- 0003-4932
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 1044.500000
British Library DSC - BLDSS-3PM
British Library STI - ELD Digital store - Ingest File:
- 24718.xml