The Cost of Postoperative Pancreatic Fistula Versus the Cost of Pasireotide

Abstract

Objective The objective of this study was to determine the costs of clinically significant postoperative pancreatic fistula (POPF), and to evaluate the cost-effectiveness of routine pasireotide use. Summary Background Data We recently completed a prospective randomized trial that demonstrated an 11.7% absolute risk reduction of clinically significant POPF with use of perioperative pasireotide in patients undergoing pancreaticoduodenectomy or distal pancreatectomy (POPF: pasireotide (n=152), 9% vs. placebo (n=148), 21%; p=0.006). Methods An institutional modeling system was utilized to obtain total direct cost data from the 300 patients included in the trial. This system identified direct costs of hospitalization, physician fees, laboratory tests, invasive procedures, outpatient encounters, and readmissions. Total direct costs were calculated from the index admission to 90 days after resection. Costs were converted to Medicare dollars. Results Clinically significant POPF occurred in 45 of the 300 randomized patients (15%). The mean total cost for all patients was $23,350 ($8,017–$202,494). The mean cost for those who developed clinically significant POPF was $39,615 ($13,770–$202,494) vs. $20,480 ($8,017–$62,941) for those who did not (p=0.001). The mean cost of pasireotide within the treatment group (n=152) was $3,316 ($273–$3,826). The mean cost was lower in the pasireotide (n=152) group than the placebo (n=148) group; however this did not reach statistical significance (pasireotide, $22,774 vs. placebo, $23,941: p=0.571). Conclusions The development of POPF nearly doubled the total cost of pancreatic resection. In this randomized trial, the routine use of pasireotide significantly reduced the occurrence of POPF without increasing the overall cost of care.

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

“…One example of a related application involves administration of pasireotide, a somatostatin analog that has been shown to significantly reduce the rate of pancreatic fistula . While pasireotide has been shown to be cost effective or cost neutral when used in all patients, studies demonstrate improved cost‐effectiveness with selective usage . Pasireotide administration protocols often require preoperative or early intraoperative dosing, and a preoperative CR‐POPF risk estimation could allow surgeons to better select which patients will benefit from pasireotide well before the day of surgery.…”

“…27 While pasireotide has been shown to be cost effective or cost neutral when used in all patients, studies demonstrate improved costeffectiveness with selective usage. [28][29][30][31] Pasireotide administration protocols often require preoperative or early intraoperative dosing, and a preoperative CR-POPF risk estimation could allow surgeons to better select which patients will benefit from pasireotide well before the day of surgery. Future studies are needed to determine the utility of preoperative risk evaluation in the context of pasireotide use, as the use of somatostatin analogs is not currently abstracted in ACS NSQIP.…”

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

“…However, changes in perioperative treatment reduced pancreatic fistula rates in prospective randomized trials: Pasireotide, a somatostatin analogue, significantly reduced the pancreatic fistula rate if administered pre-and postoperatively [36]. Moreover, treatment with pasireotide is cost-effective [37]. Postoperative therapy with other somatostatin analogs has not been shown to be effective [38].…”

HYAL‐1‐induced autophagy facilitates pancreatic fistula for patients who underwent pancreaticoduodenectomy

“…[3][4][5][6] Prevention of POPF including pancreatic duct drainage, somatostatin analogs, or biological sealants has been identified as useful strategies for decreasing the incidence of POPF. [5][6][7][8][9] Therefore, it would be crucial to screen patients with a high risk for POPF and to take optimize preoperative and intraoperative strategies for decreasing the hazard of postoperative complications.…”