Abstract
BackgroundAdhesion barriers have proven to reduce adhesion-related complications in colorectal surgery. However, barriers are seldom applied. The aim of this study was to determine the cost-effectiveness of adhesion barriers in colorectal surgery.MethodsA decision-tree model was developed to compare cost-effectiveness of no adhesion barrier with the use of an adhesion barrier in open and laparoscopic surgery. Outcomes were incidence of clinical consequences of adhesions, direct healthcare costs, and incremental cost-effectiveness ratio per adhesion prevented. Deterministic and probabilistic sensitivity analyses were performed.ResultsAdhesion barriers reduce adhesion incidence and incidence of adhesive small bowel obstruction in open and laparoscopic surgery. Adhesion barriers in open surgery reduce costs compared to no adhesion barrier ($4376 versus $4482). Using an adhesion barrier in laparoscopic procedures increases costs by $162 ($4482 versus $4320). The ICER in the laparoscopic cohort was $123. Probabilistic sensitivity analysis showed 66% and 41% probabilities of an adhesion barrier reducing costs for open and laparoscopic colorectal surgery, respectively.ConclusionThe use of adhesion barriers in open colorectal surgery is cost-effective in preventing adhesion-related problems. In laparoscopic colorectal surgery, an adhesion barrier is effective at low costs.
Highlights
Colorectal surgery commonly induces post-operative adhesion formation, causing a lifelong risk for small bowel obstruction, female infertility, and chronic visceral pain [1,2,3,4]
Decision model A decision-tree model was designed with Microsoft Office Excel 2007 that evaluated the strategy of adhesion prevention with an adhesion barrier in both open and laparoscopic colorectal surgery
Use of an adhesion barrier reduced the incidence of adhesions from 88.9% to 45.3% and the incidence of Adhesive small bowel obstruction (ASBO) from 8.6% to 6.2%
Summary
Colorectal surgery commonly induces post-operative adhesion formation, causing a lifelong risk for small bowel obstruction, female infertility, and chronic visceral pain [1,2,3,4]. Several types of adhesion barriers are developed to prevent post-operative adhesion formation after abdominal surgery. The efficacy data used were derived from second-look surgery studies, with a suggested 25–50% reduction in the number or density of adhesions with the use of a barrier [11, 12]. In the absence of data on reduction of adhesion-related readmissions with the use of a barrier, costs were extrapolated from the reduction of adhesions. Since publication of these analyses, evidence on both the burden of adhesions and the effectiveness of adhesion barriers has increased substantially. Adhesion barriers have proven to reduce adhesion-related complications in colorectal surgery. The aim of this study was to determine the cost-effectiveness of adhesion barriers in colorectal surgery
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