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. 2023 Feb 16;13(1):12.
doi: 10.1186/s13561-023-00425-y.

The economic impact of anastomotic leak after colorectal cancer surgery

Blas Flor-Lorente  1 , José Francisco Noguera-Aguilar  2 , Salvadora Delgado-Rivilla  3 , José María García-González  4 , Marcos Rodriguez-Martín  5 , Laura Salinas-Ortega  6 , Miguel Ángel Casado  6 , María Álvarez  7
Affiliations

The economic impact of anastomotic leak after colorectal cancer surgery

Blas Flor-Lorente et al. Health Econ Rev. .

Abstract

Objective: To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system.

Method: This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL.

Results: The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL.

Conclusions: The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. INTEREST OF THE STUDY: it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days.

Keywords: Anastomotic leak; Colorectal cancer; Cost; Resection; Spain; Stoma.

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Conflict of interest statement

BFL, JFNA, SDR, JMGC and MRM acknowledge receiving grants from Medtronic Ibérica, S.A. to conduct this project. LSO and MAC are full-time employed by PORIB, a consultancy firm which has received economic funding by Medtronic Ibérica, S.A. to develop this work. MA is full-time employed by Medtronic Ibérica, S.A. The authors hereby declare that this economic support has not interfered with the development of this project. The authors state that the sponsor did not participate or influence the analysis of the present study or the interpretations of its results. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Fig. 1
Fig. 1
Flow of patients after resection with anastomosis due to colorectal cancer in Spain. *The difference between patients with stoma closure ≤1 year vs. stoma closure > 1 year only impacts the cost of stoma closure; AL: anastomotic leak; CC: colon cancer; RC: rectal cancer
Fig. 2
Fig. 2
Proportion of costs (€, 2021) of AL treatment in patients with colorectal cancer. *In GROUP 3 patients, there is a decrease in the cost generated for stoma closure since a percentage of patients do not undergo stoma closure in the first year as a result of AL
Fig. 3
Fig. 3
Incremental total costs per patient* (€, 2021) of patients with vs. without AL. *In the estimation of the incremental cost of diagnosis and treatment of AL, only those resources that are modified due to the appearance of AL have been considered. In no case is it intended to capture the total cost associated with the treatment of a patient with colorectal cancer who does not have AL. Therefore, GROUPS 1, 2 and 3 reflect the incremental cost incurred by the National Health System after the onset of AL.**In GROUP 3 patients, there is a decrease in the cost generated for closure of the stoma since a percentage of patients do not have the stoma closed in the first year as a consequence of AL
See this image and copyright information in PMC

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