Original Article
Clinical Endoscopy
Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis

https://doi.org/10.1016/j.gie.2006.07.031Get rights and content

Background

Controlled trials support pancreatic-stent placement as an effective intervention for the prevention of post-ERCP acute pancreatitis in high-risk patients.

Objective

To perform a decision analysis to evaluate the most cost-effective strategy for preventing post-ERCP pancreatitis.

Design

Cost-effectiveness analysis.

Setting

Patients undergoing ERCP.

Interventions

Three competing strategies were evaluated in a decision analysis model from a third-party–payer perspective in hypothetical patients undergoing ERCP. In strategy I, none of the patients had pancreatic-stent placement. Strategy II had only those patients identified to be at high risk for post-ERCP, and, in strategy III, all patients underwent prophylactic stent placement. Probabilities of developing post-ERCP pancreatitis and the risk reduction by placement of a pancreatic stent were obtained from published information. Cost estimates were obtained from Medicare reimbursement rates.

Main Outcome Measurements

Incremental cost-effectiveness ratio (ICER) of different strategies.

Results

Strategy I was the least-expensive strategy but yielded the least number of life years. Strategy II yielded the highest number of years of life, with an ICER of $11,766 per year of life saved, and strategy III was dominated by strategy II.

Limitations

Indirect costs and pharmacologic prophylaxis were not considered in this analysis.

Conclusions

Pancreatic-stent placement for the prevention of post-ERCP pancreatitis in high-risk patients is a cost-effective strategy.

Section snippets

Materials and methods

A decision tree was constructed with decision analysis software (TreeAge Pro; TreeAge Software, Inc, Williamstown, Mass) (Fig. 1). We adhered to the recommendations of the Panel on Cost-Effectiveness in Health and Medicine for conducting and reporting a reference case analysis.14 In the baseline analysis, 3 competing strategies were compared in a 50-year-old person undergoing ERCP. The model was also analyzed with a Monte Carlo simulation technique in a hypothetical cohort of 10,000 patients

Baseline analysis

The results of the baseline analysis are shown in Table 3. The strategy I of no pancreatic-stent placement in any patient was the least-expensive strategy but yielded the least number of life years. Strategy II yielded the highest number of life years, with an ICER of $11,766 per year of life saved. Strategy III was dominated by strategy II in that it was more expensive but yielded fewer life years.

Sensitivity analysis

When 1-way sensitivity analysis was performed by varying important clinical probability and cost

Discussion

Post-ERCP pancreatitis is the most common and significant complication of ERCP. Strategies for preventing pancreatitis are of interest to every therapeutic endoscopist. Transpapillary pancreatic-stent placement recently received considerable attention. Although its postulated mechanism of facilitating transpapillary drainage of pancreatic secretion after ERCP appeals to clinical reasoning, an increasing body of published information now supports its clinical use. In this study, we evaluated the

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See CME section; p. 1035.

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