PMD31 Impact of Using a Vessel Sealer System and the Harmonic Scalpel in Hospital Outcomes and Cost of Thyroidectomy Procedures

Abstract

OBJECTIVES:To compare the clinical and cost consequences of Gadoxetic Acidenhanced magnetic resonance imaging (PV-MRI) to extracellular contrast mediaenhanced MRI (ECCM-MRI) and Multidetector Computed Tomography (MD-CT) in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand. METHODS: The clinical pathway of patients with suspected HCC from the initial imaging procedure (PV-MRI, ECCM-MRI or MD-CT) to the confirmed treatment decision was presented in an economic decision-tree model. The model compared payer relevant costs of the three diagnostic procedures as first line imaging for suspected HCC and the subsequent costs to reach a confirmed treatment decision. The probabilities and resource consumptions were estimated and validated by clinical experts through a Delphi panel process. Costs for diagnostic and treatment options were derived from published sources. , respectively. The higher acquisition cost of PV-MRI are more than compensated by the cost saving achieved through the reduced need for confirmatory imaging procedures and the reduced need for changes in the surgical protocol during resection. CONCLUSIONS: Using PV-MRI compared to ECCM-MRI and MD-CT for the first imaging in patients with suspected HCC leads to relevant cost savings for the statutory health insurance in both countries. The impact on health outcomes (e.g. mortality, quality of life) and total cost needs to be shown in an extended study approach. OBJECTIVES:To compare Gadoxetic Acid-enhanced MRI (PV-MRI) with extracellular contrast media-enhanced MRI (ECCM-MRI) and 3-phase MD-CT (MD-CT) in the planning of surgery for patients with colorectal cancer liver metastases (CRCLM). METHODS:A decision-tree model was used. The probabilities were collected and validated by radiologists and liver surgeons in Germany, Italy and Sweden using a Delphi panel process. Cost was derived from published sources and the mean costs A350

New generation cut-and-seal devices in oral and oropharyngeal cancer resection: clinical and cost-effectiveness study

“…Although ours is the first study to investigate the clinical outcomes and cost-effectiveness of using the electrothermal bipolar vessel sealing system and ultrasonic shears in oral and oropharyngeal cancer surgery, the same aspects have been studied in the field of thyroid surgery, with conflicting results. Reported benefits include a more efficient utilisation (shorter time) of the operating theatre 2 , 3 , 30 and shorter operating time, 31 consistent with our results. Hallgrimsson et al .…”

“…reported cost savings with the ultrasonic shears compared to the traditional technique, as a result of the significant decrease in operative time (30 per cent), with lower costs for drugs, personnel and operating theatre charges 4 . Da Silva et al ., by contrast, reported that ultrasonic shears and electrothermal bipolar vessel sealing increased the total cost of thyroidectomy procedures, despite the fact that mean operative times decreased by approximately 32 minutes with ultrasonic shears compared to the conventional technique 3 . This finding may be explained by the fact that there was no effect on the length of hospital stay, which we believe to be the most influential parameter in the final cost of any surgical procedure.…”

“…By contrast, the electrothermal bipolar vessel sealing system uses radiofrequency currents, released in a precise and calibrated way through a new feedback sensor system that signals the completion of coagulation 1 , 2 . Both instruments allow simultaneous cutting through a process of tissue destruction, and haemostasis through protein denaturation and fusion of the vessel walls 3 …”

The Use of Harmonic Scalpel in Open Thyroid Surgery: Is It Rewarding?

“…Regarding blood loss during thyroidcetomy, some investigators reported significant decrease in blood loss with HS use [5]. Others did not show any difference [6,13,16]. In this study HS showed significant advantages, including less intra-operative blood loss( p= 0.014) and the less use of drains( p-< 0.005).The lesser need for drains and haemostatic agents was also reported by Materzzi G et al [12].…”

“…Some of them considering the indirect money saving like: less hospital stay, less costs for hypocalcaemia management and lower non medical resources [5,12]. However, higher costs when HS is used are reported from other centers and this is mainly due to the cost of the hand piece even without considering the costs related to the generator which is usually provided to hospitals by the manufacturing company [16,18]. We think that the advantages of HS use including shorter operation time, less TH, less blood loss, less use of drains and less hospital stay compensate for the extra costs.…”