Malignant biliary obstruction: A comparison of cost for a use of metal or plastic stent for palliation in Japanese health care system

Endoscopic treatment with endoprosthesis for obstructive jaundice is a well-accepted method for palliation of obstructive jaundice and its associated symptoms. Yet, there is no consensus whether a plastic stent or metal stent to be used. The longer patency period with metal stent is a definite advantage but its high cost limits its routine use. The best use of metal stent is accomplished with consideration of patients' predicted prognosis and a medical cost in Japan. We used a simulated case scenario to calculate a cost for metal stent and non-metallic stent. Metal stent use would cost about 437 000 yen per patient at 6 months compared with 276 000-329 000 for non-metallic stents, and thus metal stent use appears to be more costly in current Japanese medical system. Longer patency rate with covered metal stent would make metal stent more favorable, and less frequent procedure would be beneficial for patients who are at their terminal stage of diseases. Alternatively, many patients would not need stent replacement after first biliary stent placement due to the nature of underlying diseases. In addition to a development of an ideal stent and an appropriate technique, our research should also aim at determining who would benefit most for each stent in our own practice, preferably in prospective randomized trial.