The following is the summary of “Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy” published in the January 2023 issue of Surgery by Highet, et al.
In laparoscopic sleeve gastrectomy, it is necessary to undertake a cost-effectiveness study of the staple-line reinforcement technique. A Concise Synopsis of the Background Information, The exponential growth in the expense of surgical procedures has brought to light the urgent requirement for evidence-based methodologies to establish the relative worth of surgical devices. In laparoscopic sleeve gastrectomy, one such device is called a staple-line reinforcement, which is believed to reduce the amount of bleeding during the procedure. This study modeled staple-line reinforcement and standard nonreinforced stapling as potential intervention arms. The rates of bleeding and leaks, as well as the costs of treatment for a period of 30 days, were acquired from national and state registries.
Values for quality-adjusted life years, or QALYs, were derived from previously published research. The pricing of the devices was derived from the available institutional data. After completing one-way and probabilistic sensitivity assessments, a final incremental cost-effectiveness ratio was computed. The investigation includes 346,530 patient records that spanned the years 2012 to 2018. The rates of complications were as follows: 0.05% for severe bleeding in both the reinforced and standard groups (P=0.8841); 0.45% compared with 0.59% for minor bleeding (P<0.0001); and 0.24% compared with 0.26% for the leak (P=0.4812). The median cost of a big bleed was $5,552 (or $3,287, or $16,817), while the median cost of a small bleed was $2,406 (or $1,861, or $3,484). Patients who did not experience a bleed, leak, or other major complications had a median cost of $1,908 ($1,712, $2,739). The cost of a leak was $9,897 ($4,589, $21,619). The median cost for patients who did not experience any serious complications was $1,908 ($1,712, $2,739).
The average additional cost of using reinforced stapling in surgery was $819.60 more than normal stapling. When compared with regular stapling, the reinforced method resulted in a gain of 0.00002 QALYs. The incremental cost-effectiveness ratio arrived at as a result was $40,553,000/QALY. Both one-way and probabilistic sensitivity analyses did not generate a value lower than $150,000/QALY. Compared to regular stapling, reinforced stapling does not minimize large postoperative bleeding or leaks and is not cost-effective when used consistently in laparoscopic sleeve gastrectomy. However, it does reduce small postoperative bleeding.
