For palliation of patients with malignant obstructive jaundice, expansile metal stents provide longer patency than plastic stents but are more expensive.
The optimal cost-effective strategy has not been established.
Our aim was to compare the relative costs of 3 strategies :
(1) plastic stent, with exchange on occlusion ;
(2) metal stent initially, with coaxial plastic stent insertion in the event of occlusion ;
or (3) plastic stent initially, with metal stent exchange in the event of occlusion.
A decision analysis model was created using DATA 2.6 software to assess the relative costs of the three strategies.
Values for variables including the probabilities of reintervention and patient survival were obtained from published data.
Costs were based on Medicare reimbursements of hospital charges, and the model was evaluated from the perspective of a third-party payer.
One-way and two-way sensitivity analysis of the variables was performed over a wide range.
The outcome is highly sensitive to the ratio of metal stent cost relative to endoscopic retrograde cholanglopancreatography cost (cost ratio M : ERCP) and to the length of survival of the patient.
The most economical strategies were (2), (3) and (1) for M : ERCP cost ratios of<0.5,0.5 to 0.7, and>0.7, respectively.
The choice of stent should be guided by the relative local costs of ERCP and metal stents and by the prognosis of the patient. (...)
Mots-clés Pascal : Compression par tumeur, Voie biliaire, Traitement, Endoprothèse, Stent, Coût, Cholangiopancréatographie, Rétrograde, Métal, Matériau plastique, Complication, Obstruction, Incidence, Epidémiologie, Homme, Appareil digestif pathologie, Voie biliaire pathologie, Tumeur maligne, Equipement biomédical, Economie santé, Radiodiagnostic, Endoscopie
Mots-clés Pascal anglais : Tumoral compression, Biliary tract, Treatment, Endoprosthesis, Stent, Costs, Cholangiopancreatography, Retrograde, Metal, Plastic material, Complication, Obstruction, Incidence, Epidemiology, Human, Digestive diseases, Biliary tract disease, Malignant tumor, Biomedical equipment, Health economy, Radiodiagnosis, Endoscopy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0260057
Code Inist : 002B26M. Création : 16/11/1999.