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Costs Analysis of Fibrin Sealant for Prevention of Anastomotic Leakage in Lower Colorectal Surgery

Authors Panda S, Connolly MP, Ramirez MG, Beltrán de Heredia J

Received 27 June 2019

Accepted for publication 3 January 2020

Published 13 January 2020 Volume 2020:13 Pages 5—11

DOI https://doi.org/10.2147/RMHP.S221008

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Kent Rondeau


Saswat Panda, 1 Mark P Connolly, 1, 2 Manuel G Ramirez, 3 Juan Beltrán de Heredia 4

1Global Market Access Solutions LLC, Charlotte, NC, USA; 2University of Groningen, Department of Pharmacy, Unit of Pharmacoeconomics, Groningen, Netherlands; 3Global HEOR Advanced Surgery, Baxter Health Care Corporation, Deerfield, MA, USA; 4General Surgery Department, Hospital Clinico Valladolid, Valladolid, Spain

Correspondence: Mark P Connolly
Global Market Access Solutions LLC, Charlotte, NC, USA
Email mark@gmasoln.com

Introduction: Postoperative anastomotic leaks remain a common and serious complication of colorectal surgeries and are a major cause of mortality and morbidity of these procedures. Anastomotic leaks (AL) have been extensively studied; however, there has been no significant reduction in their prevalence over time. In addition, there is a significant economic burden from AL attributed to the need for repeat surgery, radiologic intervention and lengthened hospital stay. We conducted a comparative cost analysis of patients undergoing colorectal surgery with anastomosis, with the application of fibrin sealant (FS) to the sutured anastomosis versus not treating the sutured anastomosis with FS.
Methods: The deterministic decision-tree model was populated with clinical data including operating room time, hospitalization days, occurrence of AL, need for revision surgery, blood products and radiologic interventions to treat the AL in lower colorectal surgery. A systematic literature review was conducted to identify appropriate studies with these variables.
Results: The average cost per case treated lower colorectal surgery with fibrin sealant glue 10 mL Tisseel® and those not treated with a fibrin sealant after suturing the anastomoses was € 3233 and € 4130, respectively, for resource expenses paid by the healthcare system. This would suggest potential savings of € 897 per surgery, achieved through the application of FS to the sutured anastomosis for preventing AL following colorectal surgery.
Conclusion: Application of FS to the sutured anastomosis in lower colorectal surgery resulted in a decrease in post-operative AL, and cost savings based on a reduction in hospitalization days, a reduction needing: revision surgery, radiologic intervention and blood products to treat AL.

Keywords: fibrin sealant, anastomoses, cost analysis, budget impact, colorectal surgery, colorectal cancer


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