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

doi:10.1016/j.hpb.2021.11.004

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

College of Medicine and Public Health

Research output: Contribution to journal › Review article › peer-review

7 Citations (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 language	English
Pages (from-to)	309-321
Number of pages	13
Journal	HPB
Volume	24
Issue number	3
Early online date	12 Nov 2021
DOIs	https://doi.org/10.1016/j.hpb.2021.11.004
Publication status	Published - Mar 2022

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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

abstract = "Background: Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS{\textregistered}) 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.",

keywords = "pancreatic cancer, surgical care, cost-effectiveness, clinical pathways, Enhanced recovery, pancreatoduodenectomy, systematic review, cost meta-analysis, trial seqeuntial analysis",

author = "Monish Karunakaran and Jonnada, {Pavan K.} and Chandrashekhar, {Sagar H.} and Gopika Vinayachandran and Billingsley Kaambwa and Barreto, {Savio G.}",

year = "2022",

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doi = "10.1016/j.hpb.2021.11.004",

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volume = "24",

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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

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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

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DO - 10.1016/j.hpb.2021.11.004

M3 - Review article

AN - SCOPUS:85120083249

SN - 1365-182X

VL - 24

SP - 309

EP - 321

JO - HPB

JF - HPB

IS - 3

ER -

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

Abstract

Keywords

UN SDGs

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