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Variety of stents similar in cost-effectiveness for pancreatic adenocarcinoma
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HONOLULU — Fully-covered, self-expandable metal stents; uncovered self-expandable metal stents; and plastic stents were similar in effectiveness for pancreatic adenocarcinoma and cost, according to a plenary presentation at ACG 2015.
Chad C. Spangler, MD, gastroenterologist, Gastroenterology and Internal Medicine Specialists in Illinois, presented data from a randomized clinical trial of 63 patients with pancreatic adenocarcinoma who started neoadjuvant chemoradiotherapy and compared three types of biliary stents: fully-covered self-expandable metal (fcSEMS), uncovered self-expandable metal (uSEMS), and plastic stents.
Chad C. Spangler
“We performed a prospective trial assessing cost effectiveness and important clinical outcomes among these three types of stems among these patients,” Spangler said during his presentation.
Primary outcomes of the study included the time to stent occlusion, death or surgical resection, according to Spangler's presentation.
According to Spangler, there are advantages and disadvantages to metal and plastic stents. For examples, advantages of plastic include they are inexpensive and are easy to place. However, there is a high risk of stent occlusion.
Overall, 26 patients were assigned to plastic stents, 20 to uSEMS and 17 to fcSEMS. The fcSEMS took 219 days for stent to occlude compared with 88 days for uSEMS and 75 days for plastic (P < .01). The groups had “equivalent” rates of stent occlusion, attempted surgical resection and mortality, despite fcSEMS having a longer time to stent occlusion.
“Plastic is less likely to occlude, but more prone to tumor ingrowth and risk of [post-ERCP pancreatitis],” Spangler said.
The metal stents are also least likely to occlude and tend to be resistant to tumor ingrowth, but are more prone to stent migration, according to Spangler.
The plastic stent group was cheaper than the other stents, with an average cost of $116 per stent at the time of study compared to $3,446 for uSEMS and $4,274 fcSEMS.
The presentation showed that uSEMS placement during index ERCP cost the most at $24,874, followed by fcSEMS at $22,729 and plastic costing $18,701 (P < .01).
The SEMS placements resulted in higher procedural complication costs per patient (uSEMS, $5,521; fcSEMS = $12,701) compared with plastic ($0, P < .01). However, plastic stents had a total hospitalization cost of $11,458 cost per patient due to stent occlusion compared with $2,301 for uSEMS and $0 for fcSEMS (P < .01).
The total cost of the index ERCP, procedural complications associated with the index ERCP and complications from stent occlusion were similar between the three stent types; fcSEMS cost $41,112; uSEMS cost $41,475; and plastic cost $39,955 (P = 1.00).
“In comparing fcSEMS, uSEMS and plastic stents for malignant biliary obstruction in patients undergoing neoadjuvant therapy with curative intent for pancreatic adenocarcinoma, no stent type was superior in optimizing cost effectiveness and important clinical outcomes,” Spangler concluded, indicating the stent of choice at his clinic is now fully covered.
Reference:
Gardner TB, et al. Abstract 49. Presented at: ACG; Oct. 16-21, 2015; Honolulu.
Disclosures: The researchers report no relevant financial disclosures.