The Value of Decision Analytical Modeling in Surgical Research

Tax, Casper; Govaert, Paulien H. M.; Stommel, Martijn W J; Besselink, Marc G.; Gooszen, Hein G.; Rovers, Maroeska M.

doi:10.1097/sla.0000000000002553

Cited by 6 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings add to existing evidence associating MIDP with reduced perioperative blood loss, time to functional recovery, length of stay, and impact on quality of life 6–9,18 . MIDP has been shown cost-effective in a decision-analytic model based on pooled observational data 45 . In addition, a cost analysis of the LEOPARD trial data found no excess costs for MIDP compared with ODP 46 .…”

Section: Discussionsupporting

confidence: 66%

“…[6][7][8][9]18 MIDP has been shown cost-effective in a decision-analytic model based on pooled observational data. 45 In addition, a cost analysis of the LEOPARD trial data found no excess costs for MIDP compared with ODP. 46 The association between conversion and increased composite major morbidity in the ACS-NSQIP population was not confirmed upon external model validation nor in the LEOPARD trial.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

International Validation of Reduced Major Morbidity After Minimally Invasive Distal Pancreatectomy Compared With Open Pancreatectomy

et al. 2019

View full text Add to dashboard Cite

in collaboration with the Dutch Pancreatic Cancer GroupObjective: To quantify the nationwide impact of minimally invasive distal pancreatectomy (MIDP) on major morbidity as compared with open distal pancreatectomy (ODP). Background: A recent randomized controlled trial (RCT) demonstrated significant reduction in time to functional recovery after MIDP compared with ODP, but was not powered to assess potential risk reductions in major morbidity. Methods: International cohort study using the American College of Surgeons' National Quality Improvement Program (ACS-NSQIP) (88 centers; 2014-2016) to evaluate the association between surgical approach (MIDP vs ODP) and 30-day composite major morbidity (CMM; death or severe complications) with external model validation using Dutch Pancreatic Cancer Group data (17 centers; 2005-2016). Multivariable logistic regression assessed the impact of nationwide MIDP rates between 0% and 100% on postoperative CMM at conversion rates between 0% and 25%, using estimated marginal effects. A sensitivity analysis tested the impact at various scenarios and patient populations. Results: Of 2921 ACS-NSQIP patients, 1562 (53%) underwent MIDP with 18% conversion, and 1359 (47%) underwent ODP. MIDP was independently associated with reduced CMM [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.42-0.60, P < 0.001], confirmed by external model validation (n ¼ 637, P < 0.003). The association between rising MIDP implementation rates and falling postoperative morbidity was linear between 0% (all ODP) and 100% (all MIDP). The absolute risk reduction for CMM was 11% (95% CI 7.3%-15%) at observed conversion rates and improved to 14% (95% CI 11%-18%) as conversion approached 0%. Similar effects were seen across subgroups. Conclusion: This international study predicted a nationwide 11% risk reduction for CMM after MIDP versus ODP, which is likely to improve as conversion rates decrease. These findings confirm secondary outcomes of the recent LEOPARD RCT.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

International Validation of Reduced Major Morbidity After Minimally Invasive Distal Pancreatectomy Compared With Open Pancreatectomy

et al. 2019

View full text Add to dashboard Cite

show abstract

“…One other previous study used decision-analytical modelling to create different scenarios and likewise found laparoscopic distal pancreatectomy to be dominant compared to open resection. 168 The assumptions for the model, however, were based on data from nonrandomized trials, which might make them less reliable.…”

Section: Discussionmentioning

confidence: 99%

Effects of Pancreatic Surgery : Quality of Life, Cost-effectiveness and Postoperative Results

Johansen

2023

Linköping University Medical Dissertations

View full text Add to dashboard Cite

show abstract

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

Hilst¹,

Strating²,

Rooij³

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost‐effectiveness and impact on disease‐specific quality of life have yet to be established. Methods The LEOPARD trial randomized patients to minimally invasive (robot‐assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease‐specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost‐effectiveness and cost–utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality‐adjusted life‐year. Results All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot‐assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference €–427 (95 per cent bias‐corrected and accelerated confidence interval €–4700 to 3613; P = 0·839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0·566 of being more cost‐effective than the open approach at a willingness‐to‐pay threshold of €0 per day of earlier recovery, and a probability of 0·676 per additional quality‐adjusted life‐year at a willingness‐to‐pay threshold of €80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i.q.r. 5·75–10) versus 7 (4–8·75); P = 0·056) and disease‐specific quality of life after minimally invasive (laparoscopic and robot‐assisted procedures) versus open distal pancreatectomy. Conclusion Laparoscopic distal pancreatectomy was at least as cost‐effective as open distal pancreatectomy in terms of time to functional recovery and quality‐adjusted life‐years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

show abstract

The Value of Decision Analytical Modeling in Surgical Research

Cited by 6 publications

References 30 publications

International Validation of Reduced Major Morbidity After Minimally Invasive Distal Pancreatectomy Compared With Open Pancreatectomy

International Validation of Reduced Major Morbidity After Minimally Invasive Distal Pancreatectomy Compared With Open Pancreatectomy

Effects of Pancreatic Surgery : Quality of Life, Cost-effectiveness and Postoperative Results

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

Contact Info

Product

Resources

About