Effectiveness and Cost-Utility of Anti-Adhesion Agents in Intra-Abdominal Surgery Patients

BACKGROUND: Adhesive intestinal obstruction (AIO) is a common and critical complication of intra-abdominal surgery, often requiring preventative measures such as using anti-adhesion agents (AAA). However, despite their prevalence and significance, a notable lack of long-term and large-scale clinical evidence exists supporting the effectiveness and cost-utility of these agents. This study aimed to evaluate the effectiveness and cost-utility of applying AAA in patients undergoing intra-abdominal surgery. METHODS: This is a retrospective observational study utilizing the Korean National Health Insurance Database in combination with the data from the Clinical Data Warehouse collected from six university-affiliated hospitals in Korea. The study included patients who underwent intra-abdominal surgeries between April and December 2016, with 2-year follow-up. The effectiveness of AAA was assessed by the incidence rate of AIO, and cost-utility was evaluated through calculating quality-adjusted life years (QALYs) and direct costs. Subgroup and sensitivity analyses were conducted to confirm the consistency and robustness of the study findings. RESULTS: A total of 2,831 patients were included in the study. Among them, 1,365 (47.2%) received AAA while 1,466 (52.8%) did not. The group that received AAA exhibited a significantly lower incidence of AIO, with a rate of 12.4% compared to 18.5% in the non-user group. Utility scores were higher in the user group, averaging 1.992 QALYs versus 1.986 in the non-user group. Direct costs were significantly lower in the user group, totaling 3,794 USD, which is 1,330 USD less than those incurred by the non-user group. Subgroup and sensitivity analyses reinforced these findings, demonstrating consistent reductions in AIO incidence, increased QALYs, and decreased costs observed across various subgroups, particularly among older patients and those without chronic conditions. CONCLUSION: These findings highlight the clinical effectiveness and cost-utility of AAA in patients undergoing intra-abdominal surgery. By significantly reducing the incidence of AIO and lowering healthcare costs, these agents provide empirical evidence supporting their broader adoption in clinical practice. This study addresses critical gaps in the understanding of postoperative management and offers valuable insights that could inform future healthcare policies.