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Cost-effectiveness analysis comparing TIPS with large volume paracentesis in cirrhotic patients with refractory ascites
e30
Electronic Poster Abstracts
FP07-05 SYSTEMATIC REVIEW AND METAANALYSIS OF FEASIBILITY, SAFETY, AND EFFICACY OF EX SITU LIVER RESECTION AND AUTOTRANSPLANTATION
FP07-06 COST-EFFECTIVENESS ANALYSIS COMPARING TIPS WITH LARGE VOLUME PARACENTESIS IN CIRRHOTIC PATIENTS WITH REFRACTORY ASCITES
T. Tuxun1, H. Wen1, J. -M. Zhao2 and J. -H. Zhang1 1 Department of Hepatobiliary & Pancreatic Surgery, and 2 The First Affiliated Hospital of Xinjiang Medical University, China Background: Ex situ liver resection and autotransplantation (ESLRA) technique have been applied in cases with hepatocaval region involvement. Despite the relative high morbidity and mortality in most reports, the technique was adopted by high volume centers. Methods: This systematic review analyze the current data regarding the feasibility, safety, and oncological efficacy of ESLRA. A meta-analysis of conversion to allotransplant, 90-day mortality, feasibility, and complication was performed. Results: A literature search revealed a total of 36 publications that met criteria, reporting data from 140 patients (82 autotransplantation, 53 ante-situm). Evidence levels were low, with highest Oxford evidence level being 4. The most common indication was colorectal liver metastasis in 36 patients. The conversion to allotransplantation rate was 5.7% (CI 2e30%), 90-day mortality 10% (CI 5e34%), in hospital mortality 10.7%, overall complication rate 36.4% (8e66%), and complications grade IIIa or higher occurred in 22% (CI 8e 87%). A standardized and unified nomenclature of this surgical technique is lacking. A standardized reporting format for complications is lacking despite the widespread use of Clavien-Dindo classification. Oncological outcome is not well documented. The most commonly topic is technical feasibility and indications for the surgical procedure. Publication bias is common due to the case series and single center report. Conclusion: The increased risk associated with the procedure appears to be balanced by the possible benefits, particularly when the lack of alternative curative approaches is considered. A unified nomenclature system with a systematic exploration with a rigid methodology such as registry analysis is strongly recommend.
L. Haddad, T. Conte, W. Andraus, P. Soarez and L. A. Carneiro D’Albuquerque São Paulo University, Brazil Aim: Determine the cost-effectiveness of TIPS (intrahepatic porto systemic shunt) compared to outpatient repeat paracentesis in cirrhotic patients with refractory ascites. Methods: Cost effectiveness study in cirrhotic patients with refractory ascites. It was developing Markov model of state of transitional model. The design of this study was mixed, using primary data to obtain the costs and secondary data to probabilities analysis. The time horizon was 3 years, the cycle time was 3 months and the prospect is a large public hospital. The health states were determined after exhaustive review of the literature. The costs associated with each health state were achieved in the respective sectors using microcost methodology in the period July 2013 to June 2015, being adjusted according to inflation. Patients were categorized according MELD score. Results: TIPS was a more effective strategy when compared to repeat paracentesis. For a large public hospital the results of the ratio of incremental cost-effectiveness (ICER) for realization of TIPS in relation to repeat paracentesis was $ 9,352.42, $ 10,369.87 and $ 17,102.46 for patients with MELD < 20, 20e29 and > 29, respectively. The incremental cost of TIPS relative to paracentesis was $ 29,720.80. Conclusion: TIPS is most cost-effective therapy when compared with paracentesis for cirrhotic patients with refractory ascites.
[Transition states for patients with refractory asc]
FP08 e Free Papers 8 (mini oral) e Pancreas: Tumors 1
FP08-01 10-YEAR OUTCOME OF THE LEEDS PATHOLOGY PROTOCOL (LEEPP) FOLLOWING PANCREATODUODENECTOMY FOR PERIAMPULLARY PANCREATIC CANCER
[Common indication of ex situ liver resection]
Y. S. Khaled1, M. Mohsin2, A. Yee2, R. Adair2, C. Macutkiewicz3, A. Aldouri3 and A. Smith3 1 HPB Surgery, University of Leeds, 2St James’s University Hospital, and 3HPB Surgery, St James’s University Hospital, United Kingdom HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
FP07-05 SYSTEMATIC REVIEW AND METAANALYSIS OF FEASIBILITY, SAFETY, AND EFFICACY OF EX SITU LIVER RESECTION AND AUTOTRANSPLANTATION
FP07-06 COST-EFFECTIVENESS ANALYSIS COMPARING TIPS WITH LARGE VOLUME PARACENTESIS IN CIRRHOTIC PATIENTS WITH REFRACTORY ASCITES
T. Tuxun1, H. Wen1, J. -M. Zhao2 and J. -H. Zhang1 1 Department of Hepatobiliary & Pancreatic Surgery, and 2 The First Affiliated Hospital of Xinjiang Medical University, China Background: Ex situ liver resection and autotransplantation (ESLRA) technique have been applied in cases with hepatocaval region involvement. Despite the relative high morbidity and mortality in most reports, the technique was adopted by high volume centers. Methods: This systematic review analyze the current data regarding the feasibility, safety, and oncological efficacy of ESLRA. A meta-analysis of conversion to allotransplant, 90-day mortality, feasibility, and complication was performed. Results: A literature search revealed a total of 36 publications that met criteria, reporting data from 140 patients (82 autotransplantation, 53 ante-situm). Evidence levels were low, with highest Oxford evidence level being 4. The most common indication was colorectal liver metastasis in 36 patients. The conversion to allotransplantation rate was 5.7% (CI 2e30%), 90-day mortality 10% (CI 5e34%), in hospital mortality 10.7%, overall complication rate 36.4% (8e66%), and complications grade IIIa or higher occurred in 22% (CI 8e 87%). A standardized and unified nomenclature of this surgical technique is lacking. A standardized reporting format for complications is lacking despite the widespread use of Clavien-Dindo classification. Oncological outcome is not well documented. The most commonly topic is technical feasibility and indications for the surgical procedure. Publication bias is common due to the case series and single center report. Conclusion: The increased risk associated with the procedure appears to be balanced by the possible benefits, particularly when the lack of alternative curative approaches is considered. A unified nomenclature system with a systematic exploration with a rigid methodology such as registry analysis is strongly recommend.
L. Haddad, T. Conte, W. Andraus, P. Soarez and L. A. Carneiro D’Albuquerque São Paulo University, Brazil Aim: Determine the cost-effectiveness of TIPS (intrahepatic porto systemic shunt) compared to outpatient repeat paracentesis in cirrhotic patients with refractory ascites. Methods: Cost effectiveness study in cirrhotic patients with refractory ascites. It was developing Markov model of state of transitional model. The design of this study was mixed, using primary data to obtain the costs and secondary data to probabilities analysis. The time horizon was 3 years, the cycle time was 3 months and the prospect is a large public hospital. The health states were determined after exhaustive review of the literature. The costs associated with each health state were achieved in the respective sectors using microcost methodology in the period July 2013 to June 2015, being adjusted according to inflation. Patients were categorized according MELD score. Results: TIPS was a more effective strategy when compared to repeat paracentesis. For a large public hospital the results of the ratio of incremental cost-effectiveness (ICER) for realization of TIPS in relation to repeat paracentesis was $ 9,352.42, $ 10,369.87 and $ 17,102.46 for patients with MELD < 20, 20e29 and > 29, respectively. The incremental cost of TIPS relative to paracentesis was $ 29,720.80. Conclusion: TIPS is most cost-effective therapy when compared with paracentesis for cirrhotic patients with refractory ascites.
[Transition states for patients with refractory asc]
FP08 e Free Papers 8 (mini oral) e Pancreas: Tumors 1
FP08-01 10-YEAR OUTCOME OF THE LEEDS PATHOLOGY PROTOCOL (LEEPP) FOLLOWING PANCREATODUODENECTOMY FOR PERIAMPULLARY PANCREATIC CANCER
[Common indication of ex situ liver resection]
Y. S. Khaled1, M. Mohsin2, A. Yee2, R. Adair2, C. Macutkiewicz3, A. Aldouri3 and A. Smith3 1 HPB Surgery, University of Leeds, 2St James’s University Hospital, and 3HPB Surgery, St James’s University Hospital, United Kingdom HPB 2016, 18 (S1), e1ee384