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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(09): E1413-E1420
DOI: 10.1055/a-1497-1562
Original article

Use of stents in patients undergoing chemotherapy for borderline resectable pancreatic cancer-causing biliary obstruction while awaiting surgery: A cost-effectiveness analysis

Majid A. Almadi
1   Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
2   Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
,
Timothy B. Gardner
3   Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
,
Yen-I Chen
1   Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
,
Viviane Adam
1   Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
,
Jeffrey Barkun
4   Department of Surgery, McGill University Health Centre, McGill University, Montréal, Québec, Canada
,
Alan Barkun
1   Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
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Abstract

Background and study aims Biliary stenting is indicated to relieve obstruction from borderline resectable pancreatic cancer while patients receive preoperative neoadjuvant therapy. We compared the cost-effectiveness of plastic versus metal biliary stenting in this setting.

Methods A decision tree analysis compares two competing types of biliary stents (initially metal vs. initially plastic) to treat malignant distal biliary obstruction while receiving neoadjuvant therapy with different scenarios including possible complications as bridge till the patient undergoes curative surgical attempt. Using published information, effectiveness was chosen as the probability of successfully reaching a state of being ready for surgery once chemotherapy was completed. Costs (2018 US$) were based on national data. A third-party payer perspective was adopted, and sensitivity analyses were performed over a time-horizon of one year.

Results Initially inserting a metal versus a plastic biliary stent was more efficacious with a higher probability of reaching the readiness for surgery endpoint (96 % vs. 85 %), on average 18 days earlier while also being less expensive (US$ 9,304 vs. US$ 11,538). Sensitivity analyses confirmed robustness of these results across varying probability assumptions of plausible ranges and remained a dominant strategy even when lowering the willingness-to-pay threshold to US$ 1,000.

Conclusions Initial metal stenting to relieve malignant biliary obstruction from borderline resectable pancreatic cancer in patients undergoing neoadjuvant therapy prior to surgery is a dominant intervention in economic terms, when compared to initially inserting a plastic biliary stent as it results in a greater proportion of patients being fit for surgery earlier and at a lower cost.

Supplementary material



Publication History

Received: 25 November 2020

Accepted: 20 April 2021

Article published online:
23 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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