title: An analysis of cost and clinical outcome in palliation for advanced pancreatic cancer.
abstract: BACKGROUND
  The optimal palliative method for patients with unresectable pancreatic cancer remains controversial.
  
  
  METHODS
  A retrospective chart review evaluated patients who underwent exploration for presumed resectable pancreatic cancer. Cost-based analysis was performed using relative value units (RVUs) that included the initial surgical procedure and any additional procedure required to achieve satisfactory palliation.
  
  
  RESULTS
  Of 96 patients (1993--2002), 6% had biliary bypass, 42% had duodenal bypass, 40% had double bypass, and 13% had no procedure with equivalent clinical outcomes. If biliary bypass was not initially performed, there was a significant incidence of biliary complications before definitive endoscopic stenting (P=.01). If duodenal bypass was not initially performed, 11% developed duodenal obstruction (P=.04). Total RVUs was highest for a double bypass and lowest for no initial surgical palliative procedure.
  
  
  CONCLUSIONS
  Although surgical bypass procedures at initial exploration provide durable palliation, these procedures are associated with greater costs.
authors.affiliation: Department of Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Mortenson
authors.forename: Hung S
authors.initials: HS
authors.lastname: Ho
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002779:Cholestasis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017219:Gastric Outlet Obstruction / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D005763:Gastroenterostomy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000191:economics / Q000628:therapy*; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology