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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Cost Analysis of Biliary Drainage Using Metal versus Plastic Stents in Hepatocellular Carcinoma Patients with
1Hepatology Department, National Liver Institute, Menoufia University, Shebin Al-Kom, Egypt.
Insights
For hepatocellular carcinoma (HCC) patients with biliary obstruction, metal stents are more cost-effective than plastic stents for biliary drainage. This approach reduces overall healthcare expenses and improves patient outcomes.
Area of Science:
- Gastroenterology
- Oncology
- Health Economics
Background:
- Biliary obstruction in hepatocellular carcinoma (HCC) management remains controversial.
- Endoscopic stenting offers a minimally invasive option to enhance patient quality of life.
Purpose of the Study:
- To conduct a cost-effectiveness evaluation of metal versus plastic stents for biliary drainage in HCC patients.
- To compare clinical efficacy and total costs in a randomized trial.
Main Methods:
- A randomized trial involving 90 patients with HCC-induced biliary obstruction.
- 1-year follow-up assessing clinical effectiveness and evaluating total direct and indirect costs.
Main Results:
- Direct costs per patient: EGP 40,857.84 (plastic) vs. EGP 21,802.62 (metal).
- Indirect costs per patient: EGP 888 (plastic) vs. EGP 454 (metal).
- Plastic stents incurred higher costs due to repeat procedures, medication, consultations, and hospitalizations.
Conclusions:
- Metal stents are a more cost-effective solution for biliary drainage in HCC patients.
- The findings support the preferential use of metal stents to optimize resource allocation.
Background:
The optimal method of biliary drainage for biliary obstruction caused by hepatocellular carcinoma (HCC) is controversial, and the possible endoscopic application of plastic and metal stents is the least invasive procedure to improve patients' quality of life.
Aim:
Our objective was to study cost evaluation based on a clinical efficacy of both procedures in a randomized trial comparing both approaches in patients with biliary obstruction caused by HCC.
Methods:
The strategy of management was based on clinical effectiveness of biliary drainage with either metal or plastic stents in 90 patients over a 1-year follow-up period. Total (direct and indirect) costs were evaluated.
Results:
The direct costs were EGP 40,857.84 and 21,802.62 per patient with plastic and metal stents, respectively. Concerning the indirect costs, EGP 888 and 454 were spent for each patient with plastic and metal stents, respectively. The differences in the costs resulted from patients with plastic stent insertion requiring more second endoscopic retrograde cholangiopancreatography procedures and more medication, medical consultation, and hospitalization during the year of follow-up.
Conclusions:
Based on this analysis, the use of metal stents rather than plastic stents in biliary drainage is more cost effective for this group of patients.
