A COST-ANALYSIS OF ND-YAG LASER-ABLATION VERSUS ENDOSCOPIC INTUBATIONFOR THE PALLIATION OF MALIGNANT DYSPHAGIA

Although endoscopic intubation is the mainstay of non-surgical palliat ion of malignant dysphagia, Nd:YAG laser ablation has been shown to pr ovide good palliation with few complications. The study reported here incorporates data from published and unpublished sources into a cost m odel which estimates the lifetime cost of palliation with the two ther apies. It is estimated that, depending on the assumptions used, laser palliation costs between pound 153 and pound 710 more per patient than endoscopic intubation. Sensitivity analysis is used to assess whether variation in clinical practice and in the unit costs of resources wil l change the conclusions of the study. This indicates that, under most alternative sets of assumptions, intubation retains its cost advantag e. However, factors that might reduce, or even eliminate, this cost di fferential include undertaking more laser procedures as day-cases, usi ng more expensive expanding metal stents for intubation and reducing t he need for follow-up laser procedures with palliative radiotherapy.