OBJECTIVES

Ostomy for fecal diversion is associated with a substantial long-term cost burden. In the UK, £233.5 million is spent annually on stoma products alone. Our objective was to assess the patient-level ostomy-associated costs in the UK, and to explore the potential impact of new approaches to avoid ostomy after rectal cancer.

METHODS

We developed a Markov model to estimate the lifetime cost of stoma care post rectal resection. Patient characteristics were based on a retrospective cohort study (age 65 years, 50.2% male). Cohort survival was calculated based on long-term survival data for rectum cancer patients reported in the SEER database and adjusted to the UK population. Monthly stoma care costs were derived from NHS guidelines for stoma product prescriptions. We assumed that 80% of the stomas would be reversed in a take-down procedure within the first year while the remaining ostomies were permanent. Stoma take-down costs were based on NHS Reference Costs for England. Conservatively, we did not consider cost of potential adverse events experienced by stoma patients. All costs were calculated over the patient’s lifetime, discounted at 3.5% p.a. Sensitivity analysis was performed to evaluate the effect of changes in assumptions.

RESULTS

In the base case, the lifetime cost of stoma management post colorectal surgery was £8,167. For patients in whom stoma was reversed, costs were £8,726, while costs for a permanent stoma patient who would not undergo take-down surgery were £5,930. Permanent stoma costs were higher in patients with higher long-term survival, as could be expected at younger treatment age and in colorectal surgery indications other than cancer.

CONCLUSIONS

Our model-based projections suggest placement of an ostomy after rectal cancer resection is associated with substantial long-term costs in the NHS. New techniques or devices that could safely avoid the stoma placement could meaningfully reduce long-term care costs.