TY - JOUR
T1 - Enhancing the cost-effectiveness of surgical care in pancreatic cancer
T2 - a systematic review and cost meta-analysis with trial sequential analysis
AU - Karunakaran, Monish
AU - Jonnada, Pavan K.
AU - Chandrashekhar, Sagar H.
AU - Vinayachandran, Gopika
AU - Kaambwa, Billingsley
AU - Barreto, Savio G.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - pancreatic cancer
KW - surgical care
KW - cost-effectiveness
KW - clinical pathways
KW - Enhanced recovery
KW - pancreatoduodenectomy
KW - systematic review
KW - cost meta-analysis
KW - trial seqeuntial analysis
UR - http://www.scopus.com/inward/record.url?scp=85120083249&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2021.11.004
DO - 10.1016/j.hpb.2021.11.004
M3 - Review article
AN - SCOPUS:85120083249
VL - 24
SP - 309
EP - 321
JO - HPB: The Official Journal of The IHPBA, EHPBA and AHPBA
JF - HPB: The Official Journal of The IHPBA, EHPBA and AHPBA
SN - 1365-182X
IS - 3
ER -