AIMS:
5F plastic pancreatic stents are recommended for the prevention of post-ERCP pancreatitis (PEP). However, these patients require further care post-procedure to confirm spontaneous stent passage and repeat endoscopy for stent removal if migration has not occurred (in approximately 20%). The development of a 6F biodegradable stent (Archimedes^TM, Q3 Medical, Dublin, IRL) which can be used for the same indications, removes the need for post-procedure care. This study aimed to evaluate the cost implications of a care pathway using biodegradable pancreatic stents compared with usual care with plastic stents.

METHODS:
A retrospective analysis was performed from Oct 2020 to Oct 2023 to identify all patients at a tertiary centre who had a plastic stent inserted for PEP. Patient data was retrieved from medical records and costs from the hospital’s finance department. Travel costs were estimated based on public transport fares. The transport cost was doubled for endoscopic stent retrievals given the requirement for a patient escort post-sedation. The incidence of follow-up imaging and endoscopy was calculated. The cost of imaging was calculated, as was the cost of repeat endoscopic procedures, including the item cost of each plastic stent. The total cost of post-plastic stent insertion care was then calculated as a mean cost per patient. The cost of a biodegradable stent was compared against the mean cost of plastic stent follow-up care.

RESULTS:
68 patients with plastic pancreatic stents for PEP from Oct 2020-Oct 2023 were included; 34 female; mean age 59 years [range 20–96]. 62 patients had one repeat x-ray and a further 6 had a second x-ray to assess for stent migration. 15 patients (22.1%) required repeat ERCP to remove the pancreatic stent. The mean return journey cost was US$50.81 for post-ERCP care, and so 104 episodes of travel (74 for x-ray, 30 for endoscopy including an escort) resulted in the patients incurring mean travel costs of $93.12. The mean cost of an x-ray was $143. The mean cost of a repeat ERCP for removal of plastic stent was $2369. Individual plastic pancreatic stents were charged at $38. The total cost of care (including patient and health service incurred costs) for 68 patients on the plastic pancreatic stent pathway was $55,375, with the mean cost per patient $814.35. The item cost of the biodegradable stent was $802.6 with no ongoing care costs. Thus, the difference in overall care cost using a biodegradable versus a plastic stent care pathway was $11.75.

CONCLUSIONS:
Biodegradable pancreatic stents may have patient care benefits over plastic pancreatic stents, including removing a need for repeat hospital visits and potential further endoscopic interventions. Despite the significantly higher item costs for biodegradable pancreatic stents, the overall costs (taking account of both patient and healthcare expenditure) are similar.

Daniel Schneider

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