banner ISPOR 1

USING A HA-CMC BARRIER TO AVOID PELVIC OR ABDOMINAL ADHESION:
COST-BENEFIT ADVANTAGES IN A PRIVATE HEALTHCARE SETTING
Cost saving for pelvic procedure considering the efficacy (5) from bio-absorbable pellicle of 54-78% and the
expenses for 100 patient. The cost save using the prophylaxis treatment will be direct cost of U$S 629,49.
OBJETIVE
$2.000,00
To demonstrate net costs reduction obtained by the prophylactic use of a HA-CMC* pellicle in specific abdominal and
pelvic surgeries.
INTRODUCTION
Abdominal and pelvic adhesion formation is a common event in consequence of surgeries made on those areas. It is
estimated that 94% of the patients develop this events (7,8).
The morbidity from adhesions can range from chronic abdominal pain to female infertility, corresponding to 34.7% for
abdominal disorders and 34,5% to gynecological disorders (12,13). Only 5,6% correspond to adhesiolysis, but
surgical lyses of adhesions may be associated with significant complications;
Accordingly, care must be taken to minimize postoperative morbidity and mortality and high costs with prophylaxis
treatment.
PROCEDURES
QUANTITY
OF PELLICLE
% COST SAVE
AVERANGE SAVE PER
100 PATIENT
Methods:
• Costs of care for the treatment of small bowel obstruction were obtained from a
• A cost-benefit economic model was developed to compare options of adopting or not the use of HA-CMC barriers
during abdominal/pelvic surgeries as a prophylactic way to avoid adhesions in these sites and one of major
consequences, the small bowel obstruction.
• Collecting data on probabilities on scientific literature for gathering risks of adhesion and other outcomes, as so the
efficacy of the bio-absorbable pellicle to avoid adhesion.
3
3- 7%
$43.373,73
Abdominal Biopsy
1
31-46%
$114.430,69
$1.400,00
Appendicectomy
3
1 - 4%
$34.803,95
$1.200,00
Colectomy
2
7-13%
$76.067,05
$1.000,00
Cholecystectomy
2
3- 4%
$94.118,64
Gastroplasty for obesity
1
8-11%
$122.779,85
Herniorrafy
1
28-39%
$121.928,71
Cost saving for abdominal procedure considering the efficacy (6,7) from bio-absorbable pellicle of 47-61% and the
expenses for 100 patient. The cost save using the prophylaxis treatment (3 unities) will be direct cost of U$S
433,74, per patient in pelvic procedures.
% COST SAVE
AVERANGE SAVE PER
100 PATIENT
Averange Pelvic procedure
3
17-22%
$62.949,26
Data source: Orizon Database - 16-million lives of private healthcare providers from Orizon, data from 3 years.
Pelivc Biopsy
1
37-48%
$142.921,46
Economic perspective: Third-payer
Caesarean
1
19-31%
$141.490,38
Endometriosis and Hysterectomy
1
12-19%
$144.312,28
Hysterectomy
1
33-54%
$144.373,04
Myomectomy
1
17-28%
$144.333,62
Oophorectomy
1
13-21%
$142.871,67
Salpingography
1
33-54%
$137.666,55
RESULTS
The average costs of primary procedure were US$ 2,607.90 for gynaecologic and US$ 5,394.67 for abdominal
interventions. In this same population, the cost of interventions to treat adhesions has shown an average cost of US$
3,918.29. It was assumed that the cost of using HA-CMC (1-3 unities) varies from US$ 262 – 786, and the efficacy of
this kind of prophylaxis varies from 54% to 78% and 47% to 61% for gynaecologic and abdominal procedures,
respectively.
BIO-ABSORBABLE
NO
PELLICLE
PROPHYLAXIS
FONTE
22-46%
95%
ELLIS H, SCOVILL WA, FAZIO VW,
Adhesion abdominal (assintomatic)
39-53%
94%
ELLIS H, SCOVILL WA, TABATA T.,
Disorder (abdominal or pelvic)
-
34,6%
BECKER JM, LOWER AM,
Propabilitie adhesiolysis
-
5,6%
TABATA T., FAZIO VW.
Cost primary procedure - pelvic
-
US$ 2,607.90
Private healthcare
Cost primary procedure - abdominal
-
US$ 5,394.67
Private healthcare
Averange cost disorder (without adhesiolysis)
-
US$ 5,978,59
Private healthcare
Averange Cost adhesiolysis
-
US$ 3,918,29
Private healthcare
Time hospitalization
-
4 days
Private healthcare
US$ 262 – 786
-
Sanofi
6-17%
-
Private healthcare
3-7%
-
Private healthcare
Cost reduction - abdominal procedure
$800,00
$600,00
$400,00
PROCEDURES
$-
CONCLUSION
Considering the frequency and average costs of each re-operation needed to treat the small bowel obstructions due
abdominal and pelvic adhesions, as the cost of prophylaxis using biodegradable barriers, it was clearly demonstrated
that this prophylaxis results in savings from the perspective of the third part payers. [*HA-CMC: hyaluronic acid –
carboxymethylcellulose (Seprafilm®,Sanofi)]
REFERENCES
Adhesion pelvic (assintomatic)
Cost reduction - pelvic procedure
$1.600,00
Averange Abdominal procedure
QUANTITY
OF PELLICLE
Cost bio-absorbalbe pellicle
$1.800,00
$200,00
METHODOLOGY
VARIABLES
Results: Cost save per patient
1. ELLIS H. Medicolegal consequences of postoperative intra-abdominal adhesions. J R Soc Med. 2001 Jul;94(7):331-2.
2. SCOVILL WA. Small bowel obstruction. In: Cameron JL, editor. Current Therapy in Surgery. St. Louis, MO: Mosby Yearbook Medical Publishers; 1995. p.100-4.
3. BASILIO PC. Obstrução intestinal por aderências: utilização de membrana bio-reabsorvível (hialuronato de sódio + carboximetilcelulose) seprafilm® na profilaxia de complicações em reoperações abdominopélvicas. Rev bras Coloproct, 2003;23(3):168-171.
4. MOHRI Y, Uchida K, Araki T, Inoue Y, Tonouchi H, Miki C, et al. Hyaluronic acid-carboxycellulose membrane (Seprafilm®) reduces early postoperative small bowel obstruction in gastrointestinal surgery. Am Surg. 2005;71:861-863.
5. TABATA T. , et al. IGCS 12th Biennial Meeting; 2008.
6. FAZIO VW. , et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006 Jan;49(1):1-11
7. BECKER JM, et al.J Am Coll Surg. 1996; 183:297-306.
8. Lower AM, Hawthorn RJ, Ellis H, O’Brien F, Buchan S and Crowe AM (2000) The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions
Research Study. BJPG 107, 855-862.
9. Ellis et AL. Adhesion-related Hospital Readmissions after Abdominal and Pelvic surgery: A retrospective Cohort study (May, 1999).
It was demonstrated that the net savings would be 6% to 17% for gynaecologic procedures and 3% to 7% for
abdominal surgeries.
International Society for Pharmacoeconomics and Outcomes Research, 18th Annual Meeting, New Orleans, USA