Economic evaluation of the use of octreotide for prevention of complications following pancreatic resection.
Recent studies have concluded that octreotide can prevent complications in patients undergoing pancreatic resections. Given the acquisition cost of octreotide, a cost-effectiveness analysis was performed to establish whether if the additional cost associated with its use was justified by a decrease in the consumption of other resources. To evaluate success rates and complication rates, a meta-analysis of double-blind, randomized, controlled clinical trials was conducted. The rates for pancreatic fistula and fluid collection were 10.7% (95% confidence interval [CI] 7.9 to 13.4) and 3.6% (95% CI 1.9 to 5.2) for octreotide vs. 23.4% (95% CI 19.7 to 27. 1) and 8.8% (95% CI 6.2 to 11.3) for placebo. In a second phase we evaluated the treatment cost for patients with and without complications using two different models of cost savings. In the first model the cost to treat a pancreatic fistula was calculated as the per diem rate (as determined by Statistics Canada) multiplied by the incremental length of stay associated with the complication. In the second model we used data from institutions participating in the Ontario Case Costing Project. In model 1 the estimated incremental length of hospital stay attributed to a pancreatic fistula was 7 days, based on a review of the literature, and the per diem was $552. In model 2 the average cost of care for patients with or without complication was $32,347 (n = 17; 95% CI $20,882 to $43,812) and $11, 169 (n = 18; 95% CI $7558 to $14,779), respectively. The data suggest that when compared to placebo, octreotide is a dominant treatment strategy. In model 1, in a cohort of 100 patients, octreotide saved an average of $853 per patient while allowing 16 incremental patients to avoid complications. In model 2 use of octreotide resulted in an average savings of $1642 per patient while still allowing 16 patients to avoid complications. Detailed one-way and two-way sensitivity analyses suggest that both models were robust. The use of octreotide is a cost-effective strategy in patients undergoing elective pancreatic resection. Consideration should be given to extending its use to patients who are at high risk for development of complications following pancreatic surgery and who do not have any contraindications to the use of this drug.
Rosenberg
L
L
Department of Surgery, McGill University Health Center and Montreal General Hospital Research Institute, Montreal, Quebec, Canada.
MacNeil
P
P
Turcotte
L
L
D015331:Cohort Studies; D016001:Confidence Intervals; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005122:Exudates and Transudates; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006728:Hormones / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015282:Octreotide / Q000191:economics / Q000627:therapeutic use*; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D010919:Placebos; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D006728:Hormones; D010919:Placebos; D015282:Octreotide