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Cost associated with diverting ostomy after rectal cancer surgery: a transnational analysis

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Abstract

Background

Diverting ileostomy and colostomy after total mesorectal excision reduces the risk of complications related to anastomotic leakages but is associated with a reduction in health-related quality of life and long-term economic consequences that are unknown. Our objective was to estimate the lifetime costs of stoma placement after rectal cancer resection in the U.S., England, and Germany.

Methods

Input parameters were derived from quasi-systematic literature searches. Decision-analytic models with survival from colorectal cancer-adjusted life tables and country-specific stoma reversal proportions were created for the three countries to calculate lifetime costs. Main cost items were stoma maintenance costs and reimbursement for reversal procedures. Discounting was applied according to respective national guidelines. Sensitivity analysis was conducted to explore the impact of parameter uncertainty onto the results.

Results

The cohort starting ages and median survival were 63 and 11.5 years for the U.S., 69 years and 8.5 years for England, and 71 and 6.5 years for Germany. Lifetime discounted stoma-related costs were $26,311, £9512, and €10,021, respectively. All three models were most sensitive to the proportion of ostomy reversal, age at baseline, and discount rate applied.

Conclusion

Conservative model-based projections suggest that stoma care leads to significant long-term costs. Efforts to reduce the number of patients who need to undergo a diverting ostomy could result in meaningful cost savings.

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Acknowledgements

The authors would like to express their gratitude to Gerd Gottschalk for collaborating on earlier stages of this work and to Simon Weber for his help in data collection and visualization.

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Authors and Affiliations

  1. Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany

    Benjamin P. Geisler

  2. Wing Tech Inc., 101 Jefferson Drive, Menlo Park, CA, USA

    Benjamin P. Geisler, Khoa N. Cao, Anne M. Ryschon & Jan B. Pietzsch

  3. Department of Surgery/Division of Colon and Rectal Surgery, UMass Memorial Health/UMass Chan Medical School, Worcester, MA, USA

    Karim Alavi

  4. Department Abdominal Surgery, Universitair Ziekenhuis Antwerpen/ReSURG, Antwerp Surgical Training, Anatomy and Research Center, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Niels Komen

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Correspondence to Jan B. Pietzsch.

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Disclosures

Wing Tech Inc. (Dr. Khoa N. Cao, Anne M. Ryschon, Dr. Jan B. Pietzsch, and—during employment—Dr, Benjamin O. Geisler) has received consulting fees from SafeHeal SAS, a maker of an investigational device to avoid or reduce stoma. Drs. Geisler, Cao, and Pietzsch and Ms. Ryschon report no other relevant conflicts of interest. Dr. Karim Alavi and Niels Komen have no conflicts of interest or financial ties to disclose.

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Geisler, B.P., Cao, K.N., Ryschon, A.M. et al. Cost associated with diverting ostomy after rectal cancer surgery: a transnational analysis. Surg Endosc 37, 7759–7766 (2023). https://doi.org/10.1007/s00464-023-10300-w

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