Objectives: This study aimed to examine the economic and clinical benefits of a new powered circular stapler for left-sided colorectal construction in China.

Methods: A decision analysis model was constructed for a cohort of patients who underwent left-sided colorectal anastomoses, using either the powered stapling systems (ECHELON CIRCULAR ^TM Powered Stapler, ECP) or the conventional manual circular staplers (MCS). The complications rates and healthcare resource utilization in the ECP cohort were obtained from a single-arm ECP trial (NCT03326895). For the MCS cohort, retrospective data from 20 Chinese tertiary hospitals were analyzed. Propensity score matching was employed to adjust for the imbalance between the two cohorts. The anastomotic leak rate, length of stay (LOS), 90-day readmission rate, and direct medical costs were used as the decision analysis model parameters. A budget impact analysis based on the decision analysis model was conducted to compare the total hospitalization expenditure between ECP and manual circular staplers.

Results: Assuming 100 procedures per year, the anastomotic the leak rate was 1.79 and 29.76 per 100 procedures in the ECP and MCS cohorts, respectively. The LOS was 1,426.91 days per 100 procedures in the ECP cohort, compared to 1,702.38 days per 100 procedures in the MCS cohort. The 90-day readmission rate was also lower in the ECP cohort than the MCS cohort (19.10 vs. 26.19 per 100 procedures). For the 100 procedures, the annual total hospitalization costs for left-sided colorectal anastomosis were reduced from RMB7,152,251 using manual circular staplers to RMB6,919,306 using ECP. Despite a higher acquisition cost of ECP compared to the manual staplers (RMB711,200 vs. RMB441,700), an annual saving of RMB232,945 in the total cost resulted from the lower rates of complications and shorter LOS.

Conclusions: The clinical and economic benefits of ECP were found in the indirect comparison for left-sided colorectal anastomoses in China.