Distal pancreatectomy without intraperitoneal drainage: a cost-effective alternative to routine drainage

Abstract

Background: The use of drains after distal pancreatectomy (DP) remains controversial. Several studies, including a randomized multicenter clinical trial (RCT), have demonstrated that the absence of intraperitoneal drainage does not increase postoperative complications. In this context, we performed a cost-utility analysis comparing distal pancreatectomy without peritoneal drainage to routine peritoneal drainage. Methods: Decision model analysis of the cost and effectiveness of DP without drainage vs with routine drainage was performed. The primary outcome was quality-adjusted life years (QALY) gained. The incremental cost-effectiveness of DP without drainage was determined from the perspective of a third-party payer. Probabilities and utilities were obtained from literature and costs from Medicare database and Agency for Health Research and Quality. Results: The base case analysis, utilizing RCT data, revealed that both strategies produced 0.8 QALYs. However, DP with drainage cost more, being dominated by DP without drainage. One-way sensitive analysis, showed the decision model was most sensitive to the inpatient costs for patients without complications, followed by inpatient costs for patients with complications. Two-way sensitivity analysis showed that DP without drainage was favored with the increase in the inpatient costs for patients with complications and when inpatient costs for patients without complications was lower than US$ 68,417. Monte Carlo simulation confirmed the base-case results. DP without drainage, when compared to with drainage, produced 0.83 QALYs vs 0.8, and it was US$ 2,105.96 cheaper. Therefore, DP with drainage remained dominated. Conclusion: In this study, distal pancreatectomy without intraperitoneal drainage was more cost-effective than routine drainage.Table 1Costs, Utilities and Cost-Effectiveness Ratios Comparing Distal Pancreatectomy without peritoneal drainage and with peritoneal drainage.Base-case analysisUtilities & costsDP without drainageDP with drainageQALYs0.800.80Incremental QALYs–0Perioperative costs (US$)64,125.6364,155.84Incremental costs (US$)–30.22Cost-effectiveness ratio79,718.5780,114.69ICER–−8510.50Cost-effective?YesDominatedAfter sensitivity analysis with Monte Carlo simulation methodQALYs0.830.80Incremental QALYs–−0.02Perioperative cost (US$)72,654.6474,760.60Incremental costs (US$)–2,105.96Cost-effectiveness ratio87,878.7993,137.57ICER–−87,494.92Cost-effective?YesDominatedICER–incremental cost-effectiveness ratio Open table in a new tab ICER–incremental cost-effectiveness ratio