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Study Finds Cost Savings With Prophylactic Octreotide in High-Risk Pancreatic Resections: Presented at ACS

By John Otrompke

CHICAGO, IL -- October 11, 2006 -- The somatostatin analog ocreotide (Sandostatin) offers clinical benefit and cost savings when used appropriately, according to a study reported here at the American College of Surgeons (ACS) 92^nd Clinical Congress.

The incidence of postoperative pancreatic fistulas remains common enough, as high as 5% to 20%, said Tsafrir Vanounou, MD, chief resident in surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

"When we cut or take a piece of the pancreas out, along with the duodenum and a piece of the stomach, you can get a leak from the pancreas. Octreotide reduces exocrine secretions from the pancreas, but it only works in people at high risk to develop a fistula," Vanounou said. Currently, octreotide is used in 56% of patients who receive the procedure, he said.

"The fistula is one of the highest causes of mortality in these patients. Before, mortality used to be up to 40% in those with fistulas, but now its closer to 10%," said Dr. Vanounou, who presented the study on October 9^th.

Previously, studies on the use of ocreotide (Sandostatin) for prevention of postoperative complications of fistulas have resulted in conflicting findings, he said. "We tried to resolve the issue in a different way," Vanounou explained.

In the study, 252 consecutive patients underwent pancreatic duodenectomy or distal pancreatectomy, and prophylactic octreotide was administered at the surgeons' discretion.

Results showed that use of the agent in low-risk patients contributed to US $1,103 in overspending per patient, but when used in high-risk patients, octreotide reduced the incidence of fistulas from 36% to 20%, and was associated with cost savings of $18,319 per patient, mostly in the form of reduced radiology and laboratory costs.

Dr. Vanounou said that his institution has developed a care path for pancreatic procedures. "The pathway also is having a significant effect on cost savings," he said.


[Presentation title: A Novel Cost-Benefit Analysis of Prophylactic Octreotide for Pancreatic Resections.]

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