Hyaluronate Carboxymethylcellulose Sheets for the Prevention of Adhesive Complications: A Model-Based Cost-Utility Analysis.

BACKGROUND Clinical trials suggest that hyaluronate carboxymethycellulose (HA/CMC) prevents adhesion-related complications after intra-abdominal surgery, but at a high upfront cost. This study evaluated the cost-effectiveness of HA/CMC for patients undergoing curative-intent open colorectal cancer surgery. METHODS Using a Markov Monte Carlo microsimulation model, we conducted a cost-utility analysis comparing the cost-effectiveness of HA/CMC at curative-intent open colorectal cancer surgery versus standard management. We considered a scenario where HA/CMC was used at the index operation only, as well as where it was used at the index operation and any subsequent operations. The perspective was that of the third-party payer. Costs and utilities were discounted 1.5% annually, with a 1-month cycle length and 5-year time horizon. Model input data were obtained from a literature review. Outcomes included cost, quality-adjusted life years (QALYs), small bowel obstructions (SBOs), and operations for SBO. RESULTS Using HA/CMC at the index operation results in an incremental cost increase of $316 and provides 0.001 additional QALYs, for an incremental cost-effectiveness ratio of $310,000 per QALY compared to standard management. In our simulated cohort of 10,000 patients, HA/CMC prevented 460 SBOs and 293 surgeries for SBO. Probabilistic sensitivity analysis found HA/CMC was cost-effective in 18.5% of iterations, at a cost-effectiveness threshold of $50,000 per QALY. Results of the scenario analysis where HA/CMC was used at the index operation and any subsequent operations were similar. CONCLUSIONS HA/CMC prevents adhesive bowel obstruction after open colorectal cancer surgery but is unlikely to be cost-effective given minimal long-term impact on health care costs and QALYs.