Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis

Monish Karunakaran, Pavan K. Jonnada, Sagar H. Chandrashekhar, Gopika Vinayachandran, Billingsley Kaambwa, Savio G. Barreto

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Background: Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS®) are increasingly utilised in patients undergoing pancreatoduodenectomy (PD). This systematic review aimed to compare the impact of CPs versus conventional care (CC) on peri-PD costs. Methods: A systematic review of major reference databases was undertaken. Quality assessment was performed using the CHEERS checklist. Incremental cost-effectiveness ratios were calculated as part of the cost-effectiveness analysis. A meta-analysis was performed using random-effects models and Trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. Results: 14 studies meeting inclusion criteria were included for full qualitative synthesis. All studies reported a reduction in overall costs, length of stay and overall complication rates for CPs when compared to CC. Meta-analysis performed on nine studies demonstrated significantly reduced costs in the CP group, with considerable heterogeneity (Pooled mean difference of $ 4.28 × 103, p < 0.01, I2 = 95%). Cost-effectiveness analysis in relation to complications demonstrated dominance of CPs over CC in being cheaper as well as more effective. TSA supported the cost benefit of enhanced-recovery CPs, displaying minimal type 1 error. Conclusion: Peri-PD CPs result in significant cost-reduction in comparison to CC.

Original languageEnglish
Pages (from-to)309-321
Number of pages13
JournalHPB
Volume24
Issue number3
DOIs
Publication statusPublished - Mar 2022

Keywords

  • pancreatic cancer
  • surgical care
  • cost-effectiveness
  • clinical pathways
  • Enhanced recovery
  • pancreatoduodenectomy
  • systematic review
  • cost meta-analysis
  • trial seqeuntial analysis

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