Basile Njei1, Thomas R McCarty2, Shyam Varadarajulu3, Udayakumar Navaneethan3. 1. Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA; Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, Connecticut, USA. 2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. 3. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
Abstract
BACKGROUND AND AIMS: Cholangiocarcinoma (CCA) is a leading cause of morbidity and mortality in patients with primary sclerosing cholangitis (PSC). Although several ERCP-based diagnostic modalities are available for diagnosing CCA, it is unclear whether one modality is more cost-effective than the others. The primary aim of this study was to compare the cost-effectiveness of ERCP-based techniques for diagnosing CCA in patients with PSC-induced biliary strictures. METHODS: We performed a cost utility analysis to assess the net monetary benefit for accurately diagnosing CCA using 5 different diagnostic strategies: (1) ERCP with bile duct brushing for cytology, (2) ERCP with brushings for cytology and fluorescence in situ hybridization (FISH)-trisomy, (3) ERCP with brushings for cytology and FISH-polysomy, (4) ERCP with intraductal biopsy sampling, and (5) single-operator cholangioscopy (SOC) with targeted biopsy sampling. A Monte Carlo simulation assessed outcomes including quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also performed. RESULTS: SOC with targeted biopsy sampling, as compared with ERCP with brushing for FISH-polysomy, produced an incremental QALY gain of .22 at an additional cost of $8562.44, resulting in a base case ICER of $39,277.25. Deterministic and probabilistic sensitivity analyses demonstrated that diagnosis with SOC was cost-effective at conventional willingness-to-pay thresholds of $50,000 and $100,000. SOC was the most cost-effective diagnostic strategy. CONCLUSIONS: SOC with biopsy sampling is the most cost-effective diagnostic modality for CCA in PSC strictures.
BACKGROUND AND AIMS: Cholangiocarcinoma (CCA) is a leading cause of morbidity and mortality in patients with primary sclerosing cholangitis (PSC). Although several ERCP-based diagnostic modalities are available for diagnosing CCA, it is unclear whether one modality is more cost-effective than the others. The primary aim of this study was to compare the cost-effectiveness of ERCP-based techniques for diagnosing CCA in patients with PSC-induced biliary strictures. METHODS: We performed a cost utility analysis to assess the net monetary benefit for accurately diagnosing CCA using 5 different diagnostic strategies: (1) ERCP with bile duct brushing for cytology, (2) ERCP with brushings for cytology and fluorescence in situ hybridization (FISH)-trisomy, (3) ERCP with brushings for cytology and FISH-polysomy, (4) ERCP with intraductal biopsy sampling, and (5) single-operator cholangioscopy (SOC) with targeted biopsy sampling. A Monte Carlo simulation assessed outcomes including quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also performed. RESULTS: SOC with targeted biopsy sampling, as compared with ERCP with brushing for FISH-polysomy, produced an incremental QALY gain of .22 at an additional cost of $8562.44, resulting in a base case ICER of $39,277.25. Deterministic and probabilistic sensitivity analyses demonstrated that diagnosis with SOC was cost-effective at conventional willingness-to-pay thresholds of $50,000 and $100,000. SOC was the most cost-effective diagnostic strategy. CONCLUSIONS: SOC with biopsy sampling is the most cost-effective diagnostic modality for CCA in PSC strictures.
Authors: Karan Kaura; Tarek Sawas; Fateh Bazerbachi; Andrew C Storm; John A Martin; Gregory J Gores; Barham K Abu Dayyeh; Mark D Topazian; Michael J Levy; Bret T Petersen; Vinay Chandrasekhara Journal: Dig Dis Sci Date: 2019-09-30 Impact factor: 3.199
Authors: Pedro Pereira; Filipe Vilas-Boas; Armando Peixoto; Patrícia Andrade; Joanne Lopes; Guilherme Macedo Journal: GE Port J Gastroenterol Date: 2017-11-08
Authors: Marina Tucci Gammaro Baldavira Ferreira; Igor Braga Ribeiro; Diogo Turiani Hourneaux de Moura; Thomas R McCarty; Alberto Machado da Ponte Neto; Galileu Ferreira Ayala Farias; Antônio Afonso de Miranda Neto; Pedro Victor Aniz Gomes de Oliveira; Wanderley Marques Bernardo; Eduardo Guimarães Hourneaux de Moura Journal: Clin Endosc Date: 2021-07-01