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Costs related to diverting ileostomy after rectal cancer surgery: a population-based healthcare cost analysis based on nationwide registers
Karolinska Institutet, Stockholm, Sweden; Enköping Hospital, Enköping, Sweden.
Karolinska Institutet, Stockholm, Sweden; Visby Hospital, Visby, Sweden.
Umeå University.
Luleå University of Technology, Luleå, Sweden; Halmstad University, Halmstad, Sweden.
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2023 (English)In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 60, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P <.001 and in-patient care P =.031). Post-secondary education (P =.003) and younger age (P =.020) was associated with a higher cost for consumables while suffering a surgical complication was associated with increased cost for inpatient care (P <.001). Patients who had their stoma longer had lower monthly costs (consumables P <.001 and in-patient care P <.001). Female gender, longer duration of stoma, young age, and higher education are associated with higher costs for the care of a diverting stoma after rectal cancer surgery. This study does not allow for analyses of causality but the results together with deepened analyses of underlying reasons form a proper basis for decisions in health care planning and allocation of resources. These findings may have implications on the debate of equal care for all.

Place, publisher, year, edition, pages
Sage Publications, 2023. Vol. 60, p. 1-8
Keywords [en]
cost analysis, defunctioning stoma, healthcare costs, ileostomy, inpatients, low anterior resection, rectal neoplasms, resource allocation, socioeconomic factors, stoma reversal
National Category
Surgery Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-218886DOI: 10.1177/00469580231212126PubMedID: 38105185Scopus ID: 2-s2.0-85180186050OAI: oai:DiVA.org:umu-218886DiVA, id: diva2:1824072
Funder
Region Västerbotten, RV-979794Region Västerbotten, RV-978927Swedish Research Council, 2021-00972Visare Norr, 930645Available from: 2024-01-04 Created: 2024-01-04 Last updated: 2024-02-08Bibliographically approved

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Näsvall, PiaGunnarsson, Ulf

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