The cost effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction

Abstract

Objective: Self-expanding metal stents have been developed to treat acute left-sided large bowel obstruction, either for palliation or for bowel decompression prior to subsequent abdominal surgery. The cost effectiveness of stenting vs surgical decompression has been analysed.

Patients and methods: Between April 1997 and April 1998, 16 patients with acute large bowel obstruction were managed by self-expanding metal stents. This group was compared with 10 unselected patients previously managed by surgical decompression. The cost-effectiveness of stenting was compared with surgical decompression by analysis of total hospital stay, running costs, and operating theatre/radiology suite utility. This was extended to include stented patients who proceeded to elective anterior resection (n=5) and patients managed by Hartmann's operation who proceeded to reversal (n=6).

Results: The results showed significant reduction in the total hospital stay in the stent group, with a mean hospital stay of 2.5 days compared with 13.5 days in the surgical decompression group. There was also a mean net saving of £1760 per stented patient, with a cumulative annual saving of £26 400 on an average of 15 cases stented per year. In patients who proceeded either to post-stenting anterior resection, or reversal of Hartmann's operation, the mean hospital stay was 17 days and 23.5 days (including hospital stay for decompression procedure), respectively, with a mean net saving of £685 per stented patient.

Conclusion: Stenting of acute large bowel obstruction is a cost-effective procedure with a reduction in total hospital stay and expenditure compared with surgical decompression.