Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial

Daisy Walter; Petra G A van Boeckel; Marcel J Groenen; Bas L A M Weusten; Ben J Witteman; Gi Tan; Menno A Brink; Jan Nicolai; Adriaan C Tan; Joyce Alderliesten; Niels G Venneman; Wim Laleman; Jeroen M Jansen; Alexander Bodelier; Frank L Wolters; Laurens A van der Waaij; Ronald Breumelhof; Frank T M Peters; Robbert C H Scheffer; Max Leenders; Meike M C Hirdes; E W Steyerberg; Frank P Vleggaar; Peter D Siersema

doi:10.1053/j.gastro.2015.03.012

Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial

Daisy Walter, Petra G A van Boeckel, Marcel J Groenen, Bas L A M Weusten, Ben J Witteman, Gi Tan, Menno A Brink, Jan Nicolai, Adriaan C Tan, Joyce Alderliesten, Niels G Venneman, Wim Laleman, Jeroen M Jansen, Alexander Bodelier, Frank L Wolters, Laurens A van der Waaij, Ronald Breumelhof, Frank T M Peters, Robbert C H Scheffer, Max LeendersMeike M C Hirdes, E W Steyerberg, Frank P Vleggaar, Peter D Siersema

University Medical Center Utrecht

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: & Aims: Endoscopic stents are placed for palliation of extra-hepatic bile duct obstruction. Although self-expandable metals stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered [uSEMS], or partially covered [pcSEMS]), is most effective and assessed costs.

METHODS: We performed a multi-center randomized trial in 219 patients at 18 hospitals in the Netherlands from February 2008 through February 2013. Patients were randomly assigned for placement of a plastic stent (n=73), uSEMS (n=75), or pcSEMS (n=71) during endoscopic retrograde cholangiopancreatography. Patients were followed for up to 1 y. Researchers were not blinded to groups. The main study endpoints included functional stent time and costs.

RESULTS: The mean functional stent times were 172 days for plastic stents, 288 days for uSEMS, and 299 days for pcSEMS (P<.005 for uSEMS and pSEMS vs plastic). Initial placement of plastic stents (€1042 or $1106) cost significantly less than of SEMS (€1973 or $2094) (P=.001). However, the total cost per patient at the end of the follow-up period did not differ significantly between plastic stents (€7320 or $7770) and SEMS (€6932 or $7356) (P=.61). Furthermore, in patients with short survival times (≤3 months) or metastatic disease, total cost per patient did not differ between plastic stents and SEMS. No differences in costs were found between pcSEMS and uSEMS.

CONCLUSION: Although placement of SEMS (uncovered or partially covered) for palliation of extra-hepatic bile duct obstruction is initially more expensive than placement of plastic stents, SEMS have longer functional time. Total costs after 1 y do not differ significantly with stent type. Dutch Clinical Trial Registration no: NTR1361.

Original language	English
Journal	Gastroenterology
DOIs	https://doi.org/10.1053/j.gastro.2015.03.012
Publication status	Published - 2015

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Walter, D., van Boeckel, P. G. A., Groenen, M. J., Weusten, B. L. A. M., Witteman, B. J., Tan, G., Brink, M. A., Nicolai, J., Tan, A. C., Alderliesten, J., Venneman, N. G., Laleman, W., Jansen, J. M., Bodelier, A., Wolters, F. L., van der Waaij, L. A., Breumelhof, R., Peters, F. T. M., Scheffer, R. C. H., ... Siersema, P. D. (2015). Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial. Gastroenterology. https://doi.org/10.1053/j.gastro.2015.03.012

@article{39168b9ce5984d7f9f8135a165ce93fc,

title = "Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial",

abstract = "BACKGROUND: & Aims: Endoscopic stents are placed for palliation of extra-hepatic bile duct obstruction. Although self-expandable metals stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered [uSEMS], or partially covered [pcSEMS]), is most effective and assessed costs.METHODS: We performed a multi-center randomized trial in 219 patients at 18 hospitals in the Netherlands from February 2008 through February 2013. Patients were randomly assigned for placement of a plastic stent (n=73), uSEMS (n=75), or pcSEMS (n=71) during endoscopic retrograde cholangiopancreatography. Patients were followed for up to 1 y. Researchers were not blinded to groups. The main study endpoints included functional stent time and costs.RESULTS: The mean functional stent times were 172 days for plastic stents, 288 days for uSEMS, and 299 days for pcSEMS (P<.005 for uSEMS and pSEMS vs plastic). Initial placement of plastic stents (€1042 or $1106) cost significantly less than of SEMS (€1973 or $2094) (P=.001). However, the total cost per patient at the end of the follow-up period did not differ significantly between plastic stents (€7320 or $7770) and SEMS (€6932 or $7356) (P=.61). Furthermore, in patients with short survival times (≤3 months) or metastatic disease, total cost per patient did not differ between plastic stents and SEMS. No differences in costs were found between pcSEMS and uSEMS.CONCLUSION: Although placement of SEMS (uncovered or partially covered) for palliation of extra-hepatic bile duct obstruction is initially more expensive than placement of plastic stents, SEMS have longer functional time. Total costs after 1 y do not differ significantly with stent type. Dutch Clinical Trial Registration no: NTR1361.",

author = "Daisy Walter and {van Boeckel}, {Petra G A} and Groenen, {Marcel J} and Weusten, {Bas L A M} and Witteman, {Ben J} and Gi Tan and Brink, {Menno A} and Jan Nicolai and Tan, {Adriaan C} and Joyce Alderliesten and Venneman, {Niels G} and Wim Laleman and Jansen, {Jeroen M} and Alexander Bodelier and Wolters, {Frank L} and {van der Waaij}, {Laurens A} and Ronald Breumelhof and Peters, {Frank T M} and Scheffer, {Robbert C H} and Max Leenders and Hirdes, {Meike M C} and Steyerberg, {E W} and Vleggaar, {Frank P} and Siersema, {Peter D}",

year = "2015",

doi = "10.1053/j.gastro.2015.03.012",

language = "English",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "Saunders",

}

Walter, D, van Boeckel, PGA, Groenen, MJ, Weusten, BLAM, Witteman, BJ, Tan, G, Brink, MA, Nicolai, J, Tan, AC, Alderliesten, J, Venneman, NG, Laleman, W, Jansen, JM, Bodelier, A, Wolters, FL, van der Waaij, LA, Breumelhof, R, Peters, FTM, Scheffer, RCH, Leenders, M, Hirdes, MMC, Steyerberg, EW, Vleggaar, FP & Siersema, PD 2015, 'Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial', Gastroenterology. https://doi.org/10.1053/j.gastro.2015.03.012

TY - JOUR

T1 - Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial

AU - Walter, Daisy

AU - van Boeckel, Petra G A

AU - Groenen, Marcel J

AU - Weusten, Bas L A M

AU - Witteman, Ben J

AU - Tan, Gi

AU - Brink, Menno A

AU - Nicolai, Jan

AU - Tan, Adriaan C

AU - Alderliesten, Joyce

AU - Venneman, Niels G

AU - Laleman, Wim

AU - Jansen, Jeroen M

AU - Bodelier, Alexander

AU - Wolters, Frank L

AU - van der Waaij, Laurens A

AU - Breumelhof, Ronald

AU - Peters, Frank T M

AU - Scheffer, Robbert C H

AU - Leenders, Max

AU - Hirdes, Meike M C

AU - Steyerberg, E W

AU - Vleggaar, Frank P

AU - Siersema, Peter D

PY - 2015

Y1 - 2015

N2 - BACKGROUND: & Aims: Endoscopic stents are placed for palliation of extra-hepatic bile duct obstruction. Although self-expandable metals stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered [uSEMS], or partially covered [pcSEMS]), is most effective and assessed costs.METHODS: We performed a multi-center randomized trial in 219 patients at 18 hospitals in the Netherlands from February 2008 through February 2013. Patients were randomly assigned for placement of a plastic stent (n=73), uSEMS (n=75), or pcSEMS (n=71) during endoscopic retrograde cholangiopancreatography. Patients were followed for up to 1 y. Researchers were not blinded to groups. The main study endpoints included functional stent time and costs.RESULTS: The mean functional stent times were 172 days for plastic stents, 288 days for uSEMS, and 299 days for pcSEMS (P<.005 for uSEMS and pSEMS vs plastic). Initial placement of plastic stents (€1042 or $1106) cost significantly less than of SEMS (€1973 or $2094) (P=.001). However, the total cost per patient at the end of the follow-up period did not differ significantly between plastic stents (€7320 or $7770) and SEMS (€6932 or $7356) (P=.61). Furthermore, in patients with short survival times (≤3 months) or metastatic disease, total cost per patient did not differ between plastic stents and SEMS. No differences in costs were found between pcSEMS and uSEMS.CONCLUSION: Although placement of SEMS (uncovered or partially covered) for palliation of extra-hepatic bile duct obstruction is initially more expensive than placement of plastic stents, SEMS have longer functional time. Total costs after 1 y do not differ significantly with stent type. Dutch Clinical Trial Registration no: NTR1361.

AB - BACKGROUND: & Aims: Endoscopic stents are placed for palliation of extra-hepatic bile duct obstruction. Although self-expandable metals stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered [uSEMS], or partially covered [pcSEMS]), is most effective and assessed costs.METHODS: We performed a multi-center randomized trial in 219 patients at 18 hospitals in the Netherlands from February 2008 through February 2013. Patients were randomly assigned for placement of a plastic stent (n=73), uSEMS (n=75), or pcSEMS (n=71) during endoscopic retrograde cholangiopancreatography. Patients were followed for up to 1 y. Researchers were not blinded to groups. The main study endpoints included functional stent time and costs.RESULTS: The mean functional stent times were 172 days for plastic stents, 288 days for uSEMS, and 299 days for pcSEMS (P<.005 for uSEMS and pSEMS vs plastic). Initial placement of plastic stents (€1042 or $1106) cost significantly less than of SEMS (€1973 or $2094) (P=.001). However, the total cost per patient at the end of the follow-up period did not differ significantly between plastic stents (€7320 or $7770) and SEMS (€6932 or $7356) (P=.61). Furthermore, in patients with short survival times (≤3 months) or metastatic disease, total cost per patient did not differ between plastic stents and SEMS. No differences in costs were found between pcSEMS and uSEMS.CONCLUSION: Although placement of SEMS (uncovered or partially covered) for palliation of extra-hepatic bile duct obstruction is initially more expensive than placement of plastic stents, SEMS have longer functional time. Total costs after 1 y do not differ significantly with stent type. Dutch Clinical Trial Registration no: NTR1361.

U2 - 10.1053/j.gastro.2015.03.012

DO - 10.1053/j.gastro.2015.03.012

M3 - Article

C2 - 25790742

SN - 0016-5085

JO - Gastroenterology

JF - Gastroenterology

ER -

Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial

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