Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy

Abstract : BackgroundGastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure. MethodsBetween April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of Euro30 000, and identification of the key drivers of ICER derived from a multivariable analysis. ResultsOne hundred and twelve patients were enrolled. The overall mean costs of gastric leak were Euro22 470; the mean(s.d.) cost was Euro24 916(12 212) in the CS arm and Euro20 024(3352) in the DPS arm (P = 0018). DPS was more cost-effective than CS (ICER Euro4743 per endoscopic procedure avoided), with an incremental net benefit of Euro25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure. ConclusionDPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible. Double pigtail is better