COST-EFFECTIVENESS OF USING ADHESION BARRIERS DURING SURGERY TO PREVENT RE-OPERATIONS FOR SMALL BOWEL OBSTRUCTION

Purpose: Adhesion barriers are used during abdominal surgery to prevent the development of adhesions that might lead to small bowel obstruction (SBO).  A published prospective randomized trial reported that rates of hospital readmission for post-surgical SBO with and without the use of an adhesion barrier were identical, but a subgroup analysis showed that adhesion barriers resulted in significantly fewer SBOs requiring surgery. In view of this difference, we evaluated the cost-effectiveness of using an adhesion barrier to diminish the need for surgery to treat SBO.

Method: A Markov model using the societal perspective was created to determine the incremental cost and expected value (quality adjusted life years, QALYs) associated with the use of adhesion barriers to prevent subsequent operations for SBO.  The base case for the model was a 45 year old patient undergoing colon surgery.  A large multi-center randomized clinical trial was used to model risks of SBO requiring readmission for medical or surgical treatment. The weighted average cost and length of hospital stay associated with medical (US$11,030, 4.0 days) versus surgical (US$24,761, 7.3 days) treatment of SBOs was obtained from the tertiary medical center at Dartmouth. The cost of the adhesion barrier (US$420 per procedure) was estimated from IMS market research data from June 2009. Sensitivity analysis was performed on all major model parameters across plausible ranges.

Result: The use of adhesion barriers during colon surgery was a dominant strategy (less expensive, greater expected value).  The incremental cost of the adhesion barrier strategy was a savings of US$100, and the incremental effectiveness was 0.167 QALY.  The use of adhesion barriers would not be a dominant cost-effective strategy if the cost of the adhesion barrier exceeded $486 per case.

Conclusion: Even though adhesion barriers do not lower overall rates of readmission for SBO, the effect of shifting SBO treatment from surgical to non-surgical makes the routine use of adhesion barriers during colon surgery a cost-effective approach.