The Answer to "When to Clip" After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis
Por:
Albeniz, E, Enguita-German, M, Gimeno-Garcia, AZ, de Tejada, AH, Nogales, O, Espinos, JC, Sanchez, JR, Roson, P, Guarner, C, Marin, JC, Bhandari, P, Spadaccini, M, Repici, A, Hassan, C, Alvarez-Gonzalez, MA, Beroiz, BI
Publicada:
1 feb 2021
Resumen:
INTRODUCTION: Delayed bleeding (DB) is the most common major complication of endoscopic mucosal resection (EMR). Two randomized clinical trials recently demonstrated that clip closure after EMR of large nonpedunculated colorectal polyps (LNPCPs) reduces the risk of DB. We analyzed the cost-effectiveness of this prophylactic measure.
METHODS: EMRs of LNCPCPs were consecutively registered in the ongoing prospective multicenter database of the Spanish EMR Group from May 2013 until July 2017. Patients were classified according to the Spanish Endoscopy Society EMR group (GSEED-RE2) DB risk score. Cost-effectiveness analysis was performed for both Spanish and US economic contexts. The average incremental cost-effectiveness ratio (ICER) thresholds were set at 54,000 euro or $100,000 per quality-adjusted life year, respectively.
RESULTS: We registered 2,263 EMRs in 2,130 patients. Applying their respective DB relative risk reductions after clip closure (51% and 59%), the DB rate decreased from 4.5% to 2.2% in the total cohort and from 13.7% to 5.7% in the high risk of the DB GSEED-RE2 subgroup. The ICERs for the universal clipping strategy in Spain and the United States, 469,706 euro and $1,258,641, respectively, were not cost effective. By contrast, selective clipping in the high-risk of DB GSEED-RE2 subgroup was cost saving, with a negative ICER of -2,194 euro in the Spanish context and cost effective with an ICER of $87,796 in the United States.
DISCUSSION: Clip closure after EMR of large colorectal lesions is cost effective in patients with a high risk of bleeding. The GSEED-RE2 DB risk score may be a useful tool to identify that high-risk population.
Filiaciones:
Albeniz, E:
Complejo Hosp Navarra, Endoscopy Unit, Dept Gastroenterol, Pamplona, Spain
Navarrabiomed UPNA IDISNA, Methodol Dept, Pamplona, Spain
Enguita-German, M:
Navarrabiomed UPNA IDISNA, Methodol Dept, Pamplona, Spain
Gimeno-Garcia, AZ:
Hosp Univ Canarias, Digest Dept, Santa Cruz De Tenerife, Spain
de Tejada, AH:
Hosp Univ Puerta Hierro, Gastroenterol Endoscopy Unit, Madrid, Spain
Nogales, O:
Hosp Gregorio Maranon, Endoscopy Unit, Madrid, Spain
Espinos, JC:
Hosp Univ Mutua Terrassa, Barcelona, Spain
Sanchez, JR:
Hosp 12 Octubre, Madrid, Spain
Roson, P:
Hosp Quiron, Malaga, Spain
Guarner, C:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Marin, JC:
Hosp 12 Octubre, Madrid, Spain
Bhandari, P:
Queen Alexandra Hosp, Endoscopy Unit, Portsmouth, Hants, England
Spadaccini, M:
Humanitas Univ, Endoscopy Dept, Milan, Italy
Repici, A:
IRCCS Ist Clin Humanitas, Dept Gastroenterol, Milan, Italy
Hassan, C:
Nuovo Regina Margherita Hosp, Endoscopy Unit, Rome, Italy
Alvarez-Gonzalez, MA:
Hosp Mar, Endoscopy Unit, Barcelona, Spain
Beroiz, BI:
Navarrabiomed UPNA IDISNA, Methodol Dept, REDISSEC, Pamplona, Spain
|