Cost analysis of indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery.

Autor: Liu RQ; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada., Elnahas A; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, University Hospital, 339 Windermere Road Room B7-216, London, ON, N6A 5A5, Canada., Tang E; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada., Alkhamesi NA; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, University Hospital, 339 Windermere Road Room B7-216, London, ON, N6A 5A5, Canada., Hawel J; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, University Hospital, 339 Windermere Road Room B7-216, London, ON, N6A 5A5, Canada., Alnumay A; Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada., Schlachta CM; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada. christopher.schlachta@lhsc.on.ca.; CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, University Hospital, 339 Windermere Road Room B7-216, London, ON, N6A 5A5, Canada. christopher.schlachta@lhsc.on.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Dec; Vol. 36 (12), pp. 9281-9287. Date of Electronic Publication: 2022 Mar 15.
DOI: 10.1007/s00464-022-09166-1
Abstrakt: Background: Indocyanine green, near infrared, fluorescence angiography (ICG-FA) is increasingly adopted in colorectal surgery for intraoperative tissue perfusion assessment to reduce anastomotic leakage rates. However, the economic impact of this intervention has not been investigated. This study is a cost analysis of the routine use of ICG-FA in colorectal surgery from the hospital payer perspective.
Methods: A decision analysis model was developed for colorectal resections considering two scenarios: resection without using ICG-FA and resection with intraoperative ICG-FA for anastomotic perfusion assessment. Incorporated into the model were the costs of ICG agent, fluorescence angiography equipment, surgery, anastomotic leak, and the leak rates with and without ICG-FA. All input data were derived from recent publications.
Results: The routine use of ICG-FA for colorectal anastomosis is cost saving when cost analysis is performed using the following base case assumptions: 8.6% leak rate without ICG-FA, odds ratio of 0.46 for reduction of leakage with ICG-FA (4.8% leak rate relative to 8.6% base case), cost of ICG-FA of $250, and incremental cost of leak, not requiring reoperation, of $9,934.50. In one-way sensitivity analyses, routine use of ICG-FA was cost saving if the cost of an anastomotic leak is more than $5616.29, the cost of ICG-FA is less than $634.44, the leak rate (without ICG-FA) is higher than 4.9%, or the odds ratio for reduction of leak with ICG-FA is less than 0.69. There is a per-case saving of $192.22 with the use of ICG-FA.
Conclusion: Using the best available evidence and most conservative base case values, routine use of ICG-FA in colorectal surgery was found to be cost saving. Since the evidence suggests there is a reduction in leak rate, the routine use of ICG-FA is a dominating strategy. However, the overall quality of evidence is low and there is a clear need for prospective, randomized controlled trials.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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