Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

Abstract

Objective: To perform a cost-effectiveness analysis of staple-line reinforcement in laparoscopic sleeve gastrectomy. Summary of Background Data: Exponential increases in surgical costs have underscored the critical need for evidence-based methods to determine the relative value of surgical devices. One such device is stapleline reinforcement, thought to decrease bleeding rates in laparoscopic sleeve gastrectomy. Methods: Two intervention arms were modeled, staple-line reinforcement and standard nonreinforced stapling. Bleed and leak rates and 30-day treatment costs were obtained from national and state registries. Qualityadjusted life-year (QALY) values were drawn from previous literature. Device prices were drawn from institutional data. A final incremental cost-effectiveness ratio was calculated, and one-way and probabilistic sensitivity analyses were performed.Results: A total of 346,530 patient records from 2012 to 2018 were included. Complication rates for the reinforced and standard cohorts were 0.05% for major bleed in both cohorts (P = 0.8841); 0.45% compared with 0.59% for minor bleed (P < 0.0001); and 0.24% compared with 0.26% for leak (P = 0.4812

The Art of Sleeve Gastrectomy

“…In a large retrospective cohort including 346,530 patients by Highet et al, reinforced stapling and non-reinforced stapling were compared [29]. Re-enforcement techniques included stapling reinforcement, oversewing or both.…”

The Varying Costs of Endoscopic Surveillance May Affect the Follow-Up Endpoint Identified by Cost-Benefit Analysis in Barrett’s Esophagus Patients Around the World

“…However, it is Q7 challenging to accept that the optimal values assessed from the costbenefit analysis are suitable for clinical practitioners around the world without considering the variable cost of endoscopic surveillance. [2][3][4] Ignoring this may make a less convincing conclusion and limit universality.…”

Comparison of Clinical Outcomes of Gripping Surface Technology Staple Reloads versus Standard Staple Reloads Used with Manual Linear Surgical Staplers

“…As such, tissue movement and slippage may be associated with increased surgical complications and untoward clinical outcomes, including surgical bleeding, leaks, and infection, associated with significant healthcare costs. 1 ECHELON FLEX™ manual staplers possess enhanced system-wide compression, which gently exudes fluid from the targeted tissue during device actuation leading to reliable performance across a diverse set of tissue types and thicknesses. In 2014, Ethicon launched the ECHELON FLEX™ GST system, a powered stapler system incorporating staple reloads with gripping surface technology (GST).…”

“…As such, tissue movement and slippage may be associated with increased surgical complications and untoward clinical outcomes, including surgical bleeding, leaks, and infection, associated with significant healthcare costs. 1 …”