Economic evaluation of palliative gastrointestinal surgery for advanced cancer patients with malignant bowel obstruction: A systematic review

Palliative surgery reduces debilitating symptoms attributable to cancer, and the intent is to improve health-related quality of life. Malignant bowel obstruction is a common indication. Despite positive clinical outcomes, there is a shortage of economic evaluation evidence to support wider adoption of palliative surgery. The aim of this review is to summarize the existing economic evaluation literature for palliative gastrointestinal surgery for advanced cancer patients with malignant bowel obstruction. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and systematic literature searches were performed using PubMed, Medline, EMBASE and Cochrane. English-language studies comparing cost outcomes of palliative gastrointestinal surgery for malignant bowel obstruction between January 2000 and April 2024 were considered. The Consolidated Health Economic Evaluation Reporting Standards 2022 were used to assess the quality of reporting, and Risk of Bias in Model-based Economic Evaluations was used to examine potential risk of bias of included studies. A total of nine papers were included, with five reporting cost outcomes only and four were full economic evaluations. Methods used, and the conditions included were heterogenous. There was a lack of consistency in methods and reporting deficits relative to the CHEERS 2022 guideline. Multiple potential sources of bias were detected. The quality of economic evaluations is quite poor. Heterogeneity among studies limits the ability to compare and generalise findings. Future research should strive to standardize methodologies, improve reporting practices, and develop more robust, high-quality economic evaluations that can better inform decision-making in palliative gastrointestinal surgery for malignant bowel obstruction.