Should ERCP be routine after an episode of “idiopathic” pancreatitis? A cost-utility analysis☆,☆☆,★,★★
Section snippets
Tree structure
Using SMLTREE software (Version 2.9, Jim Hollenberg, 1989), a decision tree (Fig. 1), was constructed with dual outcomes of utility and cost. There is a single decision node with two options, either proceeding with an outpatient ERCP a few
RESULTS
Using the baseline values, (Table 2, left hand column) the expected utility of the ERCP option is 1146.8 QALWs, whereas that of the No ERCP is 1145.8 QALWs, yielding an incremental utility gain of 1.0 QALWs per patient. This is generally referred to as a “close call” or “toss up.”33, 34 The expected cost of the ERCP option is $2729 versus $2484 for the No ERCP option, yielding an incremental cost of $245 per patient. The cost-utility ratio is $12,740 per quality-adjusted life year (QALY) gained.
DISCUSSION
To estimate the potential benefit of the ERCP option we chose to focus therapy on the identification and removal of an occult common duct stone. We did this for two reasons. First of all, expertise in interventions for such causes as pancreas divisum and gall bladder sludge is limited to select centers. By limiting our focus to occult choledocholithiasis, we believe that our results are more generalizable to community endoscopists whose primary indication for the procedure is ruling this out.
Acknowledgements
The authors gratefully acknowledge the helpful comments provided by Dr. Peter Coyte, Dr. John Howard, and Dr. William Watson, as well as the assistance of Lynda Heckendorn and Carmela O'Reilly.
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From the Victoria Hospital, The University of Western Ontario, London, Ontario, Canada, and the Toronto Hospital, The University of Toronto, Toronto, Ontario, Canada.
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Dr. Detsky is supported by a National Research Scholar Award from Health and Welfare Canada.
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Reprint requests: J.C. Gregor, MD, Room N562, Victoria Hospital, 375 South St., London, Ontario, Canada, N6A 4G5.
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