Background: Gastrojejunostomy (GJJ) and stent placement are the most commonly used palliative treatments for malignant gastric outlet obstruction (GOO). In a recent randomized trial, stent placement was preferred in patients with a relatively short survival and GJJ in patients with a longer survival. As health economic aspects have only been studied in general terms, we estimated the cost of GJJ and that of stent placement in such patients. Methods: In the SUSTENT study, patients were randomized to GJJ (n = 18) or stent placement (n = 21). Pancreatic cancer was the most common cause of GOO. We compared initial costs and costs during follow-up. For cost-effectiveness, the incremental cost-effectiveness ratio was calculated. Results: Food intake improved more rapidly after stent placement than after GJJ, but long-term relief of obstructive symptoms was better after GJJ. More major complications (P = 0.02) occurred and more reinterventions were performed (P < 0.01) after stent placement than after GJJ. Initial costs were higher for GJJ compared to stent placement (€8315 vs. €4820, P < 0.001). We found no difference in follow-up costs. Total costs per patient were higher for GJJ compared to stent placement (€12433 vs. €8819, P = 0.049). The incremental cost-effectiveness ratio of GJJ compared to stent placement was €164 per extra day with a gastric outlet obstruction scoring system (GOOSS) ≥2 adjusted for survival. Conclusions: Medical effects were better after GJJ, although GJJ had higher total costs. Since the cost difference between the two treatments was only small, cost should not play a predominant role when deciding on the type of treatment assigned to patients with malignant GOO (ISRCTN 06702358).

Cost-effectiveness, Duodenal stent placement, Gastric outlet obstruction, Gastrojejunostomy
dx.doi.org/10.1007/s00535-009-0181-0, hdl.handle.net/1765/28153
Journal of Gastroenterology
Erasmus MC: University Medical Center Rotterdam

Jeurnink, S.M, Polinder, S, Steyerberg, E.W, Kuipers, E.J, & Siersema, P.D. (2010). Cost comparison of gastrojejunostomy versus duodenal stent placement for malignant gastric outlet obstruction. Journal of Gastroenterology, 45(5), 537–543. doi:10.1007/s00535-009-0181-0