Survival, stent patency, and cost-effectiveness of plastic biliary stent versus metal biliary stent for palliation in malignant biliary obstruction in a developing country tertiary hospital

Abstract

Background and Aim: Patients with advanced malignant obstructive jaundice often require biliary drainage. Resources restraint makes clinicians need to outweigh effectiveness of each biliary stents and their costs. Hence, a cost-effectiveness analysis is necessary. Methods: A retrospective cohort study was done on malignant biliary obstruction patients undergoing palliative biliary stenting between January 2015 and December 2018. We evaluated 180-day survival rate using log-rank test and stent patency duration using Mann–Whitney U test. Effectiveness was defined as stent patency, while cost was calculated using hospital perspective using decision tree model and reported as incremental cost-effectiveness ratio. Results: A total of 81 men and 83 women were enrolled in this study. One hundred and eighty days survival rate was 35.9% (median 76 days, 95% confidence interval [CI] 50–102 days) and 33.3% (median 55 days, 95% CI 32–78 days), while average stent patency was 123 (8) days versus 149 (13) days for plastic and metal stent groups, respectively (P > 0.05). Metal stent could save Indonesian Rupiah (IDR) 1 217 750 to get additional 26 days of patency. Conclusion: There were no differences in survival and stent patency between the two groups. Metal biliary stent is more cost-effective than plastic stent for palliation in malignant biliary obstruction.