Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden

<p/> <p>Background</p> <p>Acute surgery in the management of malignant colonic obstruction is associated with high morbidity and mortality. The use of self-expanding metal stents (SEMS) is an alternative method of decompressing colonic obstruction. SEMS may allow time to optimize the patient and to perform preoperative staging, converting acute surgery into elective. SEMS is also proposed as palliative treatment in patients with contraindications to open surgery. Aim: To review our experience of SEMS focusing on clinical outcome and complications. The method used was a review of 75 consecutive trials at SEMS on 71 patients based on stent-protocols and patient charts.</p> <p>Findings</p> <p>SEMS was used for palliation in 64 (85%) cases and as a bridge to surgery in 11 (15%) cases. The majority of obstructions, 53 (71%) cases, were located in the recto-sigmoid. Technical success was achieved in 65 (87%) cases and clinical decompression was achieved in 60 (80%) cases. Reasons for technical failure were inability to cannulate the stricture in 5 (7%) cases and suboptimal SEMS placement in 3 (4%) cases. Complications included 4 (5%) procedure-related bowel perforations of which 2 (3%) patients died in junction to post operative complications. Three cases of bleeding after SEMS occurred, none of which needed invasive treatment. Five of the SEMS occluded. Two cases of stent erosion were diagnosed at the time of surgery. Average survival after palliative SEMS treatment was 6 months.</p> <p>Conclusion</p> <p>Our results correspond well to previously published data and we conclude that SEMS is a relatively safe and effective method of treating malignant colonic obstruction although the risk of SEMS-related perforations has to be taken into account.</p

Economic evaluation of platelet-rich-plasma versus hyaluronic acid for the treatment of knee osteoarthritis. Scenarios to 1 and 5 years

Purpose: The increasing incidence of total joint arthroplasty reflects the rises of osteoarthritis (OA) prevalence. OA is a degenerative pathology affecting joints with a significant impact on quality of life causing pain, leading to social life limitations and loss of work productivity. According to the World Health Organization, OA is one of the most important causes of people's disability. The burden of the disease is correlated with a huge economic impact on the health care systems. Intra-articular infiltration therapies are used between the pharmacological and the surgical phases, in order to delay surgery. This work aims to carry out an economic evaluation on the use of the Platelet-Rich-Plasma (PRP) therapy in the treatment of knee OA. The comparator is the hyaluronic acid, i.e. the standard therapy for drug-resistant OA that does not benefit or has short term benefits (<1 month) with intra-articular corticosteroids.Methods: A cost-effectiveness analysis has been performed using a decision-analytic model considering two scenarios: short period and medium period. The effectiveness outcomes are reported in term of quality-adjusted life-years (QALYs), while costs are expressed in euro ((sic)). The adopted perspective is the Italian National Health System (INHS). The results are shown through the incremental cost-effectiveness ratio (ICER) examining the PRP versus the comparator. Moreover, deterministic and probabilistic sensitivity analyses have been performed to test the robustness of the results.Results: The PRP therapy, for patients with moderate to severe knee OA in the Italian context, is cost-effective versus HA with ICERs of (sic)1,524/QALY in the 1 year and (sic)162/QALY in the 5 year scenarios.Conclusions: In the short term, it seems that the PRP therapy is cost-effective in the treatment of knee OA versus the HA therapy. However, more research is needed to assess its cost-effectiveness in the long term and to figure out if this treatment may be an efficient resource allocation for the INHS