Original ArticleClinical EndoscopyPancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis
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
References (39)
- et al.
Prevention of post-ERCP pancreatitis: a comprehensive review
Gastrointest Endosc
(2004) - et al.
Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts
Gastroenterology
(1991) - et al.
Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction
Gastroenterology
(1998) - et al.
Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients
Gastrointest Endosc
(1993) - et al.
Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study
Gastrointest Endosc
(2003) - et al.
Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones
Gastrointest Endosc
(2001) - et al.
Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique
Gastrointest Endosc
(1998) - et al.
Safety and outcome of endoscopic snare excision of the major duodenal papilla
Gastrointest Endosc
(2002) - et al.
Endoscopic management of adenoma of the major duodenal papilla
Gastrointest Endosc
(2004) - et al.
Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success
Gastrointest Endosc
(2004)
Accuracy and complication rate of brush cytology from bile duct versus pancreatic duct
Gastrointest Endosc
Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials
Gastrointest Endosc
Risk factors for post-ERCP pancreatitis: a prospective, multicenter study
Gastrointest Endosc
Risk factors for complications after performance of ERCP
Gastrointest Endosc
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
A convenient approximation of the life expectancy (the DEALE). II. Use in medical decision making
Am J Med
Cost-effectiveness of testing for hypercoagulability and effects on treatment strategies in patients with deep vein thrombosis
Am J Med
Oral anticoagulation strategies after a first idiopathic venous thromboembolic event
Am J Med
Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism
Chest
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See CME section; p. 1035.