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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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| Published in: | ANZ journal of surgery 2023-04, Vol.93 (4), p.963-969 |
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| cites | cdi_FETCH-LOGICAL-c3538-1f083fe0cff756997bc7ddfdf0872a34268c07e6aac73131aeb40f90dacaae583 |
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| container_issue | 4 |
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| container_title | ANZ journal of surgery |
| container_volume | 93 |
| creator | Shannon, Nicholas Brian Seow‐En, Isaac Tan, Emile Kwong‐Wei |
| description | 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. |
| doi_str_mv | 10.1111/ans.18148 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2735893147</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2800023556</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-1f083fe0cff756997bc7ddfdf0872a34268c07e6aac73131aeb40f90dacaae583</originalsourceid><addsrcrecordid>eNp1kcFO3DAQhq2KqlDaQ1-gssSlHBbsOImTI1oBRULtoe05mnXGlZETL54EtDeOPfKMfZIO7LaHSvhgj-1vfsv_L8QHrU40j1MY6UQ3umxeiQNdltWi0K3d29W6NGZfvCW6UUrXdVu9EfumNlWjVHEgfi0TTb8fHtF7dFO4wxGJpEvDGnKgNMrkZY8RNtjLO8w0kwzDgH2ACRmLCUaIkiea0pAokPQpxnQfxp9yjlMGrvl6whxSlhnp6RWW9c87N3Gzg9Fhfidee4iE73frofhxcf59-Xlx_fXyanl2vXCmMs1Ce9UYj8p5b6u6be3K2b73PR_bAkxZ1I1TFmsAZ402GnBVKt-qHhwAVo05FJ-2uuucbmekqRsCOYwRRkwzdYVla1qjS8vo0X_oTZoz_5cpdk8Vpqpqpo63lMuJKKPv1jkMkDedVt1TPB3H0z3Hw-zHneK8YhP_kX_zYOB0C9yHiJuXlbqzL9-2kn8AI2ieXw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2800023556</pqid></control><display><type>article</type><title>Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer</title><source>Wiley</source><creator>Shannon, Nicholas Brian ; Seow‐En, Isaac ; Tan, Emile Kwong‐Wei</creator><creatorcontrib>Shannon, Nicholas Brian ; Seow‐En, Isaac ; Tan, Emile Kwong‐Wei</creatorcontrib><description>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.</description><identifier>ISSN: 1445-1433</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.18148</identifier><identifier>PMID: 36358002</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>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</subject><ispartof>ANZ journal of surgery, 2023-04, Vol.93 (4), p.963-969</ispartof><rights>2022 Royal Australasian College of Surgeons.</rights><rights>2023 Royal Australasian College of Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-1f083fe0cff756997bc7ddfdf0872a34268c07e6aac73131aeb40f90dacaae583</citedby><cites>FETCH-LOGICAL-c3538-1f083fe0cff756997bc7ddfdf0872a34268c07e6aac73131aeb40f90dacaae583</cites><orcidid>0000-0002-0771-5063 ; 0000-0001-8287-6812 ; 0000-0001-8742-8285</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.18148$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.18148$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36358002$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shannon, Nicholas Brian</creatorcontrib><creatorcontrib>Seow‐En, Isaac</creatorcontrib><creatorcontrib>Tan, Emile Kwong‐Wei</creatorcontrib><title>Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>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.</description><subject>Anal Canal - surgery</subject><subject>Anastomosis</subject><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic leak</subject><subject>Anastomotic Leak - prevention & control</subject><subject>Anastomotic Leak - surgery</subject><subject>Cancer</subject><subject>Cancer surgery</subject><subject>Colon - surgery</subject><subject>Colorectal cancer</subject><subject>colorectal surgery</subject><subject>Complications</subject><subject>Cost analysis</subject><subject>Cost control</subject><subject>cost effectiveness</subject><subject>Cost-Benefit Analysis</subject><subject>Decision trees</subject><subject>Dehydration</subject><subject>delayed coloanal anastomosis</subject><subject>Economic analysis</subject><subject>Effectiveness</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Ileostomy</subject><subject>Maintenance costs</subject><subject>Morbidity</subject><subject>Ostomy</subject><subject>Parenteral nutrition</subject><subject>Postoperative Complications - etiology</subject><subject>Rectal Neoplasms - complications</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum</subject><subject>Rectum - surgery</subject><subject>Retrospective Studies</subject><subject>Risk reduction</subject><subject>Sensitivity analysis</subject><subject>State Medicine</subject><subject>stoma</subject><subject>Surgery</subject><issn>1445-1433</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kcFO3DAQhq2KqlDaQ1-gssSlHBbsOImTI1oBRULtoe05mnXGlZETL54EtDeOPfKMfZIO7LaHSvhgj-1vfsv_L8QHrU40j1MY6UQ3umxeiQNdltWi0K3d29W6NGZfvCW6UUrXdVu9EfumNlWjVHEgfi0TTb8fHtF7dFO4wxGJpEvDGnKgNMrkZY8RNtjLO8w0kwzDgH2ACRmLCUaIkiea0pAokPQpxnQfxp9yjlMGrvl6whxSlhnp6RWW9c87N3Gzg9Fhfidee4iE73frofhxcf59-Xlx_fXyanl2vXCmMs1Ce9UYj8p5b6u6be3K2b73PR_bAkxZ1I1TFmsAZ402GnBVKt-qHhwAVo05FJ-2uuucbmekqRsCOYwRRkwzdYVla1qjS8vo0X_oTZoz_5cpdk8Vpqpqpo63lMuJKKPv1jkMkDedVt1TPB3H0z3Hw-zHneK8YhP_kX_zYOB0C9yHiJuXlbqzL9-2kn8AI2ieXw</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Shannon, Nicholas Brian</creator><creator>Seow‐En, Isaac</creator><creator>Tan, Emile Kwong‐Wei</creator><general>John Wiley & Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0771-5063</orcidid><orcidid>https://orcid.org/0000-0001-8287-6812</orcidid><orcidid>https://orcid.org/0000-0001-8742-8285</orcidid></search><sort><creationdate>202304</creationdate><title>Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer</title><author>Shannon, Nicholas Brian ; Seow‐En, Isaac ; Tan, Emile Kwong‐Wei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-1f083fe0cff756997bc7ddfdf0872a34268c07e6aac73131aeb40f90dacaae583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anal Canal - surgery</topic><topic>Anastomosis</topic><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic leak</topic><topic>Anastomotic Leak - prevention & control</topic><topic>Anastomotic Leak - surgery</topic><topic>Cancer</topic><topic>Cancer surgery</topic><topic>Colon - surgery</topic><topic>Colorectal cancer</topic><topic>colorectal surgery</topic><topic>Complications</topic><topic>Cost analysis</topic><topic>Cost control</topic><topic>cost effectiveness</topic><topic>Cost-Benefit Analysis</topic><topic>Decision trees</topic><topic>Dehydration</topic><topic>delayed coloanal anastomosis</topic><topic>Economic analysis</topic><topic>Effectiveness</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Ileostomy</topic><topic>Maintenance costs</topic><topic>Morbidity</topic><topic>Ostomy</topic><topic>Parenteral nutrition</topic><topic>Postoperative Complications - etiology</topic><topic>Rectal Neoplasms - complications</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum</topic><topic>Rectum - surgery</topic><topic>Retrospective Studies</topic><topic>Risk reduction</topic><topic>Sensitivity analysis</topic><topic>State Medicine</topic><topic>stoma</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shannon, Nicholas Brian</creatorcontrib><creatorcontrib>Seow‐En, Isaac</creatorcontrib><creatorcontrib>Tan, Emile Kwong‐Wei</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shannon, Nicholas Brian</au><au>Seow‐En, Isaac</au><au>Tan, Emile Kwong‐Wei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2023-04</date><risdate>2023</risdate><volume>93</volume><issue>4</issue><spage>963</spage><epage>969</epage><pages>963-969</pages><issn>1445-1433</issn><eissn>1445-2197</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>36358002</pmid><doi>10.1111/ans.18148</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0771-5063</orcidid><orcidid>https://orcid.org/0000-0001-8287-6812</orcidid><orcidid>https://orcid.org/0000-0001-8742-8285</orcidid></addata></record> |
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| 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 |
| title | Cost‐effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer |
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