Cost-effectivenees Analysis of the Use of Power Circular Versus Manual Circular Staplers for Left-side Colorectal Anastomosis

Abstract

Abstract BACKGROUND Colorectal anastomotic leakage causes severe consequences for patients and health care system as it will lead to an increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to asses if the use of the new powered circular stapler is cost-effective. METHOD Observational study including patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity and the consumption of hospital resources and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was realized. RESULTS Anastomotic leakage rates were significant different (p=0.012); 22 patients (13.3%) in the manual group (9.1% treated surgically and 4.2% managed conservatively) and 8 patients (4.8%) in the powered group (3.6% treated surgically and 1.8% managed conservatively). The effectiveness for powered stapler was 98.27%, while the effectiveness of manual stapler was 93.69 %. The average cost per patient in the powered group was €6,238.38, compared with €9,700.12 in the manual group. The incremental cost-effectiveness ratio was -€74,915.28€ per patient without anastomotic complications. CONCLUSION The incremental cost of powered circular staple compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks.