Alternative techniques of feeding gastrostomy in children: a critical analysis
Goretsky M J, Johnson N, Farrell M, Ziegler M M
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Feeding gastrostomy techniques.
Type of intervention
Treatment.
Economic study type
Cost-effectiveness analysis.
Study population
Children in need of primary feeding gastrostomy due to altered mental status, feeding mechanical difficulties, or failure to thrive. Mean age was 49.1 (+
Setting
Hospital. The economic study was carried out in Ohio, USA.
Dates to which data relate
Effectiveness and resource data were collected during the period 1991-1993. The price date was not specified.
Source of effectiveness data
Effectiveness data were derived from a single study.
Link between effectiveness and cost data
Costing was undertaken retrospectively on the same patient population as that used in the effectiveness study.
Study sample
The study comprised 98 children: 47 in the Stamm group, 32 in the PEG group and 19 in the PFGG group. No power calculations were reported.
Study design
The study was a retrospective cohort, single centre study. The duration of the observation or follow-up period was not reported. There was no loss to follow-up.
Analysis of effectiveness
The analysis was based on intention to treat. Health outcome was assessed in terms of complications after the intervention. Groups were generally comparable in terms of demographic features, except for the fact that a statistically significantly greater number of children aged less than two years were placed in the PEG group for clinical reasons (p<0.05). It seems that the comparability of groups on the basis of the clinical reasons for gastrostomy was not statistically assessed.
Effectiveness results
Complications after PEG, Stamm and PFGG occurred in 19%, 11% and 16% of patients respectively. These differences were not statistically significant (p>0.05).
Measure of benefits used in the economic analysis
Since the clinical study did not show statistically significant differences between treatment groups, the economic analysis was carried out in terms of costs only.
Direct costs
Costs and quantities were not reported separately. The resources costed included: operating room or fluoroscopy room time, materials and equipment, ancillary services, professional fee charges. Costs were based on actual data (unit of analysis). Charge data were used. The price date was not specified.
Statistical analysis of costs
A one-way analysis of variance and Tukey's studentized range test were used. Mean values, standard errors and p-values were reported.
Currency
US dollars ($).
Sensitivity analysis
No sensitivity analysis was carried out.
Estimated benefits used in the economic analysis
Not applicable.
Cost results
Total mean costs (charges) +/- SE were:
PEG: $3,314 (+/- 94.88);
Stamm: $3,101.29 (+/- 63.33);
PFGG: $1,485.77 (+/- 74.41).
The difference between the PFGG costs and the other two groups was statistically significant (p<0.05).
Synthesis of costs and benefits
Not applicable.
Authors' conclusions
The authors concluded that there is no significant difference in the three feeding-access techniques when comparing procedural cost-effectiveness. Until better evidence from a prospective analysis is available, the choice of the procedure should be individualised.
CRD COMMENTARY - Selection of comparators
A justification was given for the comparators used. An open Stamm gastronomy, a percutaneous endoscopic gastronomy (PEG), and percutaneous placement of a fluoroscopically guided catheter (PFGG) are all commonly utilised feeding gastronomy methods. You, as a user of this database, should consider whether these are widely used techniques in your own setting.
Validity of estimate of measure of benefit
In the effectiveness analysis the comparability between groups in terms of the clinical indications for performing the procedure is questionable. No power calculations were used to ensure adequate sample size, and hence, the equal effectiveness may be due to type II error. Moreover the PEG group consisted of higher risk patients than the other groups, and this could have led to potential biases.
Validity of estimate of costs
The resource quantities were not reported separately from costs. The costs estimation was not reported in adequate detail.
Other issues
Considering the problems related to study design it is not clear whether the authors' conclusion regarding the similar cost-effectiveness of the three techniques can be considered fully justified.
Source of funding
None stated.
Bibliographic details
Goretsky M J, Johnson N, Farrell M, Ziegler M M. Alternative techniques of feeding gastrostomy in children: a critical analysis. Journal of the American College of Surgeons 1996; 182(3): 233-240