Category: New Technology: Miscellaneous
Introduction & Objective :
Metallic stents (MS) are increasingly used for the management of chronic ureteric obstruction (CUO) with reported advantages of longer indwelling times and better drainage than conventional polymeric stents (PS). We compared the clinical outcomes and costs, in two different healthcare payment models, of MS (Resonance®, Cook Medical) with the use of PS in both malignant and benign CUO.
Methods : Clinical data including outcomes for all ureteric stents inserted for long-term management of CUO from all causes in our institution from 2014 to 2017 were retrospectively reviewed and compared between MS and PS episodes. Stent failure was defined as complication occurrence with obstruction, urosepsis or malposition with either type of stent in-situ. For cost analysis, we calculated the average cost of each inserted stent per indwelling day for both self-paying and co-paying government subsidised (Medicaid like) healthcare models. This took into account hospital and procedural charges, stent cost and indwelling duration of MS and PS stents with an arbitrary cut-off date of 1 Nov 2017 for stents that have yet to reach their due date for removal or change.
Results : A total of 247 stents were placed in 63 patients (mean age 61 ± 13, Female n=121 (49%)) over the 3 year study period. Of these, 18% (n=45) were MS episodes and the remainder 82% (n=202) were PS. 70% (n=174) of stent insertion episodes were for malignant obstruction and 30% (n=73) were for benign obstruction. For both malignant and benign CUO, there was no significant difference in age, race and obstructive cause between MS and PS stent groups but were different significantly in terms of gender. In terms of outcomes for all causes of CUO, there was no significant difference in terms of operative time (29.0 ± 21.1 vs. 28.7 ± 30.1 min); creatinine change (3.88 ± 23.68 vs. 0.43 ± 58.74 umol/L) and stent failure rates (n=7 (15.6%) vs. n =23 (11.4%)) between MS and PS groups respectively. Equivalent patency meant that the mean indwelling stent duration was significantly greater for MS than for PS (228.6 ± 147.0 vs. 146.1 ± 66.0 days, p<0.0001) resulting in lower average stent change per patient of 1.4 and 6.3 respectively. Despite the higher cost of MS compared to PS (S$977.50 vs. S$195.50), there was no significant mean cost difference between MS and PS in both self-paying and co-paying patients.
Resonance® MS is a cost-effective option to manage CUO from malignant and benign causes regardless of self-payee or co-payee healthcare systems because its significantly longer indwelling time mitigates the higher unit cost of the stent.
National University Hospital
Singapore, Not Applicable, Singapore
Zhou Ang, Medical Officer, National University Hospital
MBBS (NUS, Singapore) 2015