eP452 - Economic Outcomes Comparing Double-row vs. Triple-row Circular Staplers: A Payer’s Perspective

Purpose/Background: Circular staplers are widely used for creating anastomoses in colorectal procedures. Stapler choice could affect the integrity of the anastomoses. Our goal is to evaluate the economic impact of manual, triple-row circular staplers (TCS) versus powered, double-row circular staplers (DCS) used for colorectal procedures.Methods/Interventions: A cost-consequence model was developed from a payer’s perspective using Microsoft Excel. The model compared anastomotic leak (AL) rates between DCS and TCS. Index length of stay (LOS), and costs ($U.S., 2023) were obtained from the Center for Medicare & Medicaid Services Diagnosis Related Group (CMS DRG) table. AL rates, 30-day all-cause readmission, LOS, and costs were obtained from literature review. The 30-day all-cause readmissions were included only among those with AL. Cost was defined as national average Medicare reimbursement to the facility. Thus, the cost components included index hospitalization, 30-day all-cause readmission and device price. All model inputs are mentioned in Table 1. To check the robustness of the model, multiple one-way, deterministic-sensitivity analyses were performed.Results/Outcomes: In a hypothetical cohort of 1,000 colorectal procedures, TCS had 10 expected leaks compared to 18 for DCS. The incremental index LOS and cost due to AL for TCS were 25 days and $42,675 compared to 53 days and $90,471 for DCS, respectively. Use of TCS resulted in a net-savings of about $43,696 after deducting device price. Similar results were observed for 30-day rehospitalization - TCS had 11 fewer days and a net-saving of $39,590 compared to DCS. Multiple one-way sensitivity analyses showed the model is most sensitive to DCS AL rates, followed by TCS AL rates.Conclusion/

Discussion: In colorectal procedures, use of TCS results in fewer AL cases, shorter LOS and lower costs when compared to DCS.Table 1Description of Model Inputs