Cost-Effectiveness and Cost-Only Studies for Inflammatory Bowel Disease Surgery: A Scoping Review.

Abstract

Introduction: Studies examining the cost-effectiveness of surgical procedures and surgery-related interventions in patients with inflammatory bowel disease (IBD) remain limited. This dearth of studies hampers decision-makers' assessment of surgery-related interventions for patients with IBD. This study aimed to conduct a scoping review of the available literature for cost-effectiveness analyses of IBD-related surgery.

Methods: We performed a comprehensive search in common publication registries. Preplanned controlled vocabulary related to IBD and its subtypes, surgery, and cost measures were used. We defined the study selection criteria to include all IBD-related surgical interventions that also reported a measure of costs of care. Studies for medical versus surgical interventions for refractory IBD were excluded. All search findings were screened by two reviewers using titles, abstracts, and ultimately full-length manuscripts. Fully screened studies were then extracted to facilitate a qualitative synthesis of results.

Results: We identified seven formal cost-effectiveness studies and 55 cost only studies. Cost-effectiveness studies assessed intraoperative (42.9%) and postoperative interventions (57.1%), mostly in patients with Crohn's disease (71.4%). Topics included surgical approaches (42.8%), venous thromboembolism prophylaxis (28.6%), and surveillance for postoperative recurrence (28.6%). Of the cost only studies, most focused on intraoperative interventions (81.8%), particularly in ulcerative colitis patients (45.5%). Predefined areas with no reported interventions included enhanced recovery interventions, robotic surgery, timing to surgery, perianal disease, pediatric disease, and genetic testing.

Conclusions: This scoping review found minimal cost-effectiveness literature to inform IBD-related surgical care. There were many more cost only studies than cost-effectiveness studies related to these clinical topics. This asymmetry highlights immediately available opportunities to broaden the use of cost-effectiveness analyses for IBD-related surgical interventions.