Cost study of metal stent placement vs single-dose brachytherapy in the palliative treatment of oesophageal cancer

Self-expanding metal stent placement and single-dose brachytherapy are commonly used for the palliation of oesophageal obstruction due to inoperable oesophagogastric cancer. We randomised 209 patients to the placement of an Ultraflex stent (n=108) or single-dose brachytherapy (12 Gy, n=101). Cost comparisons included comprehensive data of hospital costs, diagnostic interventions and extramural care. We acquired detailed information on health care consumption from a case record form and from monthly home visits by a specialised nurse. The initial costs of stent placement were higher than the costs of brachytherapy (€1500 vs €570; P<0.001). Total medical costs were, however, similar (stent €11 195 vs brachytherapy €10 078, P>0.20). Total hospital stay during follow-up was 11.5 days after stent placement vs 12.4 days after brachytherapy, which was responsible for the high intramural costs in both treatment groups (stent €6512 vs brachytherapy €7982, P>0.20). Costs for medical procedures during follow-up were higher after stent placement (stent €249 vs brachytherapy €168, P=0.002), while the costs of extramural care were similar (€1278 vs €1046, P>0.20). In conclusion, there are only small differences between the total medical costs of both palliative treatment modalities, despite the fact that the initial costs of stent placement are much higher than those of brachytherapy. Therefore, cost considerations should not play an important role in decision making on the appropriate palliative treatment strategy for patients with malignant dysphagia.