Health Economics of Adhesions
Adhesions are a major source of patient morbidity and healthcare costs. They account for an estimated 75% of cases of small bowel obstruction1 and up to 40% of infertility cases2, and contribute to nearly 50% of cases of chronic pelvic pain.3
Adhesions from a previous surgery can result in increased complications in subsequent surgeries, as well as postoperative morbidity. A study of 120 patients undergoing midline laparotomy demonstrated that a history of previous surgery significantly increased the operating time during subsequent surgery by a median of 18 minutes due to increased incision time and additional time required to divide adhesions.4
Treatment of adhesions poses a considerable financial burden on the healthcare system. A widely publicized study by Fox Ray et al (1994) demonstrated that adhesiolysis accounted for5 :
- Approximately 303,000 hospitalizations
- Approximately 850,000 days of inpatient care
- $1.3 billion in hospital and surgical expenditures
Cost-Effectiveness and SEPRAFILM®
A 2006 decision analysis study by Bristow et al evaluated the cost-effectiveness of adhesion prevention with SEPRAFILM in patients undergoing radical hysterectomy for treatment of cervical cancer. The model demonstrated that using SEPRAFILM as an adhesion prevention strategy is cost-effective from both third-party payer and societal perspectives.6
Study Details
A hypothetical patient cohort model was used to estimate the impact of using SEPRAFILM to manage the risk of adhesive small bowel obstruction (ABSO) following radical hysterectomy. The two arms of the analysis were identical, except for the probability of ASBO and chronic pelvic pain, depending on whether or not an adhesion barrier had been applied at the time of surgery. The analysis of the model was done both from the societal perspective and that of a third-party payer.
Approximations of the quality of well-being indices for colitis and exacerbation of Crohn’s disease were used to estimate the impact of ASBO on quality adjusted life years (QALYs). QALYs attributable to chronic pelvic pain were calculated using an approximation of the quality of well-being indices for severe back pain and migraine headache.
The estimate of societal costs included the cost of the adhesion prevention barrier, direct and indirect costs of hospitalization with professional reimbursement for each episode of adhesive small bowel obstruction (ASBO), estimates of lost wages and caregiver support, and lost QALYs due to hospitalization, recovery time, and death as a result of ASBO. The estimate of third-party payer costs included direct costs of hospitalization and professional reimbursement for each episode of ASBO.
Results
- From a societal perspective, which includes direct and indirect costs, the treatment cost per patient including routine care and incorporating an adhesion prevention strategy was $1,932. Treatment cost per patient using routine care with no preventative strategy was $3,043.
- Among patients treated with an adhesion prevention strategy in addition to routine care, QALY scores were 7.901 versus 7.805 among patients treated with routine care alone.
- The cost per patient to a third-party payer when using adhesion prevention strategies was $1,247. Cost per patient to a third-party payer when using routine surgery alone was $1,629.