Cost analysis of a long-term randomized controlled study in biliary duct-to-duct anastomotic stricture after liver transplantation.

Abstract

Multiple plastic stent (MPS) for biliary anastomotic stricture (AS) after liver transplantation requires multiple procedures with consequent costs. To compare the success, adverse events and treatment-related costs of fully covered self-expandable metal stents (FCSEMS) versus MPS. Thirty liver transplant (LT) patients with clinically relevant naïve AS were prospectively randomized to FCSEMS or MPS, with stent numbers increased at 3-month intervals. Treatment costs per patient were calculated for endoscopic retrograde cholangiopancreatography (including all devices and stents) and overall hospital stay. Radiological success was achieved in 73% of FCSEMS (median indwelling period of 6 mos) and 93% of MPS patients (P = NS) (median period of 11 mos). AS recurrence occurred in 36% of FCSEMS and 7% of MPS patients (P = NS), and AS re-treatment was needed in 53% and 13% (P < 0.01), respectively, during follow-up of 60 (34-80) months. Stents migrated after 29% and 2.6% of FCSEMS and MPS procedures, respectively (P < 0.01). Including re-treatments, long-term clinical success was achieved in 28/30 (93%) patients. Overall treatment-related costs were similar between groups. In the subgroup of LT patients in clinical remission after first-line treatment, treatment costs were 41% lower per FCSEMS patient compared with MPS patients. FCSEMS did not perform better than MPS. FCSEMS migration increased the rate of re-treatment and costs.

• Authors: Paolo Cantù, Giulio Santi, Roberto Rosa, Ilaria Parzanese, Federico Macchini, Andrea Tenca, Ilaria Fanetti, Federica Invernizzi, Maria Francesca Donato, Pietro Lampertico, Paolo Reggiani, Giorgio Rossi, Maurizio Vecchi, Roberto Penagini
• Journal: Transplant international : official journal of the European Society for Organ Transplantation (Transpl Int) Vol. 34 Issue 5 Pg. 825-834 (05 2021) ISSN: 1432-2277 [Electronic] Switzerland
• PMID: 33730421 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd.

Topics

• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis (etiology)
• Constriction, Pathologic (etiology)
• Health Care Costs
• Humans
• Liver Transplantation (adverse effects)
• Self Expandable Metallic Stents
• Stents
• Treatment Outcome