Cost Comparison of Peri-Strips Dry®/Peri-Strips Dry with Veritas® (PSD/PSD-V) Versus Seamguard® in Gastric Staple Line Reinforcement (SLR) | Biomedgrid

Background: A recent meta-analysis of staple line complications (SLC) in primary bariatric/metabolic procedures showed significantly lower (p<0.05) SLC rates for bovine pericardium (Peri-Strips Dry/Peri-Strips Dry with Veritas (PSD/PSD-V); Baxter Healthcare, Deerfield, IL) compared to biocompatible glycolide copolymer buttress (Seamguard; W.L. Gore & Associates, Inc, Flagstaff, AZ), suture reinforcement (oversewing), and no reinforcement. Objective: The aim of this study is to assess the impact of staple line reinforcement (SLR) choice on costs and clinical outcomes of primary bariatric/ metabolic procedures from the hospital administrator perspective in four countries – the United States (US), Brazil, Colombia, and Mexico. Methods: The cost-consequence model assesses PSD/PSD-V vs. Seamguard, oversewing, or no SLR. Epidemiologic inputs are from the literature. Clinical inputs are from the literature (SLC rates and operating room (OR) time per procedure) or are based on US databases (US SLC rates, product volume per procedure). Product costs are US average sales price. Other cost inputs (complications, OR time and oversewing) are from government sources. All costs are reported in 2018 country currencies. One-way sensitivity analyses using 95% confidence intervals or +/-20% and probabilistic sensitivity analyses (PSA) using Monte Carlo simulation for 5000 iterations evaluate key drivers of costs. Results: Analysis was completed based on hospitals conducting 100 primary bariatric/metabolic procedures annually. Reinforcement of gastric staple lines with PSD/PSD-V vs current approach mix would lead to fewer complications and reduction in surgical time leading to net cost savings. PSD/PSD-V remains a dominant strategy (fewer complications, lower costs) in the PSA. Net annual cost savings would be US$27,537, R$152,399, COL$139.81 million and Mex$1,854,032, for US, Brazil, Colombia and Mexico respectively. Conclusion: Hospital administrators can expect cost savings associated with decreased complications and OR time equivalent to or up to 2 times greater than the additional product acquisition cost when PSD/PSD-V is used for gastric SLR.