The cost effectiveness of self‐expanding metal stents in the management of malignant left‐sided large bowel obstruction

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Abstract
Self-expanding metal stents have been developed to treat acute left-sided large bowel obstruction, either for palliation or for bowel decompression prior to subsequent abdominal surgery. The cost effectiveness of stenting vs surgical decompression has been analysed. Between April 1997 and April 1998, 16 patients with acute large bowel obstruction were managed by self-expanding metal stents. This group was compared with 10 unselected patients previously managed by surgical decompression. The cost-effectiveness of stenting was compared with surgical decompression by analysis of total hospital stay, running costs, and operating theatre/radiology suite utility. This was extended to include stented patients who proceeded to elective anterior resection (n=5) and patients managed by Hartmann’s operation who proceeded to reversal (n=6). The results showed significant reduction in the total hospital stay in the stent group, with a mean hospital stay of 2.5 days compared with 13.5 days in the surgical decompression group. There was also a mean net saving of £1760 per stented patient, with a cumulative annual saving of £26 400 on an average of 15 cases stented per year. In patients who proceeded either to post-stenting anterior resection, or reversal of Hartmann’s operation, the mean hospital stay was 17 days and 23.5 days (including hospital stay for decompression procedure), respectively, with a mean net saving of £685 per stented patient. Stenting of acute large bowel obstruction is a cost-effective procedure with a reduction in total hospital stay and expenditure compared with surgical decompression.