Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer

Background Following ultralow anterior resection for distal rectal cancers, a coloanal anastomosis is usually created along with a defunctioning ileostomy (DI). Recent evidence suggests that abdominoperineal pull‐through with delayed coloanal anastomosis (DCAA) is a viable alternative to immediate c...

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Bibliographic Details
Published in:ANZ journal of surgery 2023-04, Vol.93 (4), p.963-969
Main Authors: Shannon, Nicholas Brian, Seow‐En, Isaac, Tan, Emile Kwong‐Wei
Format: Article
Language:English
Subjects:
Anal Canal - surgery
Anastomosis
Anastomosis, Surgical - methods
Anastomotic leak
Anastomotic Leak - prevention & control
Anastomotic Leak - surgery
Cancer
Cancer surgery
Colon - surgery
Colorectal cancer
colorectal surgery
Complications
Cost analysis
Cost control
cost effectiveness
Cost-Benefit Analysis
Decision trees
Dehydration
delayed coloanal anastomosis
Economic analysis
Effectiveness
Hospitalization
Humans
Ileostomy
Maintenance costs
Morbidity
Ostomy
Parenteral nutrition
Postoperative Complications - etiology
Rectal Neoplasms - complications
Rectal Neoplasms - surgery
Rectum
Rectum - surgery
Retrospective Studies
Risk reduction
Sensitivity analysis
State Medicine
stoma
Surgery
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Summary:Background Following ultralow anterior resection for distal rectal cancers, a coloanal anastomosis is usually created along with a defunctioning ileostomy (DI). Recent evidence suggests that abdominoperineal pull‐through with delayed coloanal anastomosis (DCAA) is a viable alternative to immediate coloanal anastomosis (ICAA), minimizing the risk of anastomotic leakage and avoiding the need for stoma creation with the risk of stoma‐associated morbidity. However, DCAA requires a longer initial hospitalization. We aimed to perform a cost‐effectiveness analysis to compare DCAA versus ICAA for elective rectal cancer surgery. Methods A decision tree model was used to compare the cost‐effectiveness of the two strategies. Cost data were obtained from the 2019 to 2020 United Kingdom National Health Service reference costs. Model probabilities were derived from published studies. Univariate and probabilistic sensitivity analyses were used to evaluate the robustness of the results. Results DCAA was the overall cheaper strategy at £13 541 compared with £14 856 for ICAA in the base case analysis. This was explained by the decreased overall costs of hospitalization/surgery, reduction in costs associated with anastomotic or stoma‐related complications, specifically dehydration‐induced hospital readmissions and avoidance of stoma maintenance costs. Sensitivity analysis demonstrated that DCAA remained consistently more inexpensive except when the duration of total parenteral nutrition exceeded 14 days. Conclusion Despite a longer index hospitalization with higher initial costs, this economic analysis demonstrates that DCAA without stoma is overall more cost‐effective compared with ICAA with DI following ultralow anterior resection. Cost savings should be considered an additional benefit when selecting the DCAA approach for rectal cancer surgery. The study compared delayed coloanal anastomosis (DCAA) with immediate coloanal anastomosis (ICAA). DCAA is overall more cost‐effective compared to ICAA with DI following ultralow anterior resection. Cost savings should be considered an additional benefit when selecting the DCAA approach for low rectal cancer surgery.
ISSN:1445-1433
1445-2197
DOI:10.1111/ans.18148