Authors' objectives:

This systematic review examines the clinical and cost-effectiveness of the Sugarbaker procedure for treating pseudomyxoma peritonei (PMP) and the costs of the procedure in the UK.

Authors' results and conclusions: There appears to be some benefit for people with PMP who undergo treatment with the Sugarbaker procedure. People with PMP have an estimated 5-year and 10-year survival of approximately 50% and 18%, respectively. In contrast, the survival rate of patients following the Sugarbaker procedure is about 90% at 2 years, 60% to about 90% at 3 years, depending on details of IPEC, and 60% to about 68% at 10 years. The percentage of patients with no evidence of disease at the end of follow-up after the Sugarbaker procedure ranged from 41 to 82%. Similarly, the percentage of patients alive with disease at the end of follow-up ranged from 9 to 35%. Mortality due to disease ranged from 2 to 31% in the included studies of the Sugarbaker procedure. Commonly reported complications of the Sugarbaker procedure were anastomotic leaks, fistula formation, wound infection, small bowel perforations/obstructions and pancreatitis.

Authors' recommendations: Limitations of the calculations: The economic results should be seen as merely an example of the likely marginal costs of the Sugarbaker procedure. No policy decision can be made from cost statements without more information about the current alternative. Other questions concerning the capacity and finances of the chosen method have to be left to others. Implications of Sugarbaker for PMP: If the National Specialist Commissioning Advisory Group were to support the development of additional specialist centres within the NHS, there may be several barriers to implementation. The Sugarbaker procedure requires trained and experienced staff and inevitably there will be the need for a period of training and time costs involved in developing the appropriate teams. Although the procedure requires some specialist equipment and maintenance, such as smoke evacuators, these should have limited effect on setting up the service. PMP is a relatively rare condition with approximately 50 new cases per year in the UK and the impact of an increase in the demand for services should be limited.

Authors' methods: Systematic review, Economic modelling

Project Status: Completed

URL for project: http://www.hta.ac.uk/1327

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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