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; Ewout 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, Ewout W. Steyerberg, Frank P. Vleggaar, Peter D. Siersema

^*Corresponding author for this work

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

108 Citations (Scopus)

Abstract

BACKGROUND & AIMS: Endoscopic stents are placed for palliation of extrahepatic bile duct obstruction. Although self-expandable metal stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered SEMS [uSEMS], or partially covered SEMS [pcSEMS]) is the most effective and we assessed costs. METHODS: We performed a multicenter randomized trial in 219 patients at 18 hospitals in The Netherlands from February 2008 through February 2013. Patients were assigned randomly for placement of a plastic stent (n = 73), uSEMS (n = 75), or pcSEMS (n = 71) during endoscopic retrograde cholangiopancreatography. Patients were followed up for up to 1 year. Researchers were not blinded to groups. The main study end points 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 pcSEMS vs plastic). The initial placement of plastic stents ((sic)1042 or $1106) cost significantly less than placement of SEMS ((sic)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 ((sic)7320 or $7770) and SEMS ((sic)6932 or $7356) (P = .61). Furthermore, in patients with short survival times (

Original language	English
Pages (from-to)	130-138
Number of pages	9
Journal	Gastroenterology
Volume	149
Issue number	1
DOIs	https://doi.org/10.1053/j.gastro.2015.03.012
Publication status	Published - Jul-2015

Keywords

ERCP
Pancreatic Cancer
Cost Comparison
Randomized Trial
MALIGNANT BILIARY OBSTRUCTION
PANCREATIC-CARCINOMA
POLYETHYLENE STENTS
STRICTURES
JAUNDICE
ENDOPROSTHESIS
MULTICENTER
TANNENBAUM
MANAGEMENT
GUIDELINE

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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, 149(1), 130-138. https://doi.org/10.1053/j.gastro.2015.03.012

@article{8cc764aca6254c568127e3ee1f19248b,

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 extrahepatic bile duct obstruction. Although self-expandable metal stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered SEMS [uSEMS], or partially covered SEMS [pcSEMS]) is the most effective and we assessed costs. METHODS: We performed a multicenter randomized trial in 219 patients at 18 hospitals in The Netherlands from February 2008 through February 2013. Patients were assigned randomly for placement of a plastic stent (n = 73), uSEMS (n = 75), or pcSEMS (n = 71) during endoscopic retrograde cholangiopancreatography. Patients were followed up for up to 1 year. Researchers were not blinded to groups. The main study end points 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 pcSEMS vs plastic). The initial placement of plastic stents ((sic)1042 or $1106) cost significantly less than placement of SEMS ((sic)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 ((sic)7320 or $7770) and SEMS ((sic)6932 or $7356) (P = .61). Furthermore, in patients with short survival times (",

keywords = "ERCP, Pancreatic Cancer, Cost Comparison, Randomized Trial, MALIGNANT BILIARY OBSTRUCTION, PANCREATIC-CARCINOMA, POLYETHYLENE STENTS, STRICTURES, JAUNDICE, ENDOPROSTHESIS, MULTICENTER, TANNENBAUM, MANAGEMENT, GUIDELINE",

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, {Ewout W.} and Vleggaar, {Frank P.} and Siersema, {Peter D.}",

year = "2015",

month = jul,

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

language = "English",

volume = "149",

pages = "130--138",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "W B SAUNDERS CO-ELSEVIER INC",

number = "1",

}

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, vol. 149, no. 1, pp. 130-138. 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, Ewout W.

AU - Vleggaar, Frank P.

AU - Siersema, Peter D.

PY - 2015/7

Y1 - 2015/7

N2 - BACKGROUND & AIMS: Endoscopic stents are placed for palliation of extrahepatic bile duct obstruction. Although self-expandable metal stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered SEMS [uSEMS], or partially covered SEMS [pcSEMS]) is the most effective and we assessed costs. METHODS: We performed a multicenter randomized trial in 219 patients at 18 hospitals in The Netherlands from February 2008 through February 2013. Patients were assigned randomly for placement of a plastic stent (n = 73), uSEMS (n = 75), or pcSEMS (n = 71) during endoscopic retrograde cholangiopancreatography. Patients were followed up for up to 1 year. Researchers were not blinded to groups. The main study end points 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 pcSEMS vs plastic). The initial placement of plastic stents ((sic)1042 or $1106) cost significantly less than placement of SEMS ((sic)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 ((sic)7320 or $7770) and SEMS ((sic)6932 or $7356) (P = .61). Furthermore, in patients with short survival times (

AB - BACKGROUND & AIMS: Endoscopic stents are placed for palliation of extrahepatic bile duct obstruction. Although self-expandable metal stents (SEMS) remain patent longer than plastic stents, they are more expensive. We aimed to evaluate which type of stent (plastic, uncovered SEMS [uSEMS], or partially covered SEMS [pcSEMS]) is the most effective and we assessed costs. METHODS: We performed a multicenter randomized trial in 219 patients at 18 hospitals in The Netherlands from February 2008 through February 2013. Patients were assigned randomly for placement of a plastic stent (n = 73), uSEMS (n = 75), or pcSEMS (n = 71) during endoscopic retrograde cholangiopancreatography. Patients were followed up for up to 1 year. Researchers were not blinded to groups. The main study end points 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 pcSEMS vs plastic). The initial placement of plastic stents ((sic)1042 or $1106) cost significantly less than placement of SEMS ((sic)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 ((sic)7320 or $7770) and SEMS ((sic)6932 or $7356) (P = .61). Furthermore, in patients with short survival times (

KW - ERCP

KW - Pancreatic Cancer

KW - Cost Comparison

KW - Randomized Trial

KW - MALIGNANT BILIARY OBSTRUCTION

KW - PANCREATIC-CARCINOMA

KW - POLYETHYLENE STENTS

KW - STRICTURES

KW - JAUNDICE

KW - ENDOPROSTHESIS

KW - MULTICENTER

KW - TANNENBAUM

KW - MANAGEMENT

KW - GUIDELINE

U2 - 10.1053/j.gastro.2015.03.012

DO - 10.1053/j.gastro.2015.03.012

M3 - Article

SN - 0016-5085

VL - 149

SP - 130

EP - 138

JO - Gastroenterology

JF - Gastroenterology

IS - 1

ER -

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

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Keywords

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