Surgical endoscopy · 2025
Endoscopic ultrasound-guided biliary drainage is cost-effective for treatment of malignant distal biliary obstruction after failed ERCP.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Siranart Noppachai, Pajareya Patavee, Steinway Steven N
Аннотация
BACKGROUND: Endoscopic ultrasound (EUS)-guided biliary drainage is a promising alternative for malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the cost-effectiveness of EUS-guided gallbladder drainage (EUS-GB) and EUS-guided choledochoduodenostomy (EUS-CBD) compared to percutaneous transhepatic biliary drainage (PTBD) in these patients.
METHODS: A decision analysis model compared costs and quality-adjusted life years (QALYs) over two years for patients with MDBO after failed ERCP, undergoing EUS-GB, EUS-CBD, or PTBD. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were calculated at a willingness-to-pay threshold of $100,000 per QALY. Probabilistic and deterministic sensitivity analyses were performed.
RESULTS: Both EUS-GB and EUS-CBD were more cost-effective than PTBD. PTBD cost $14,988, EUS-GB cost $14,520 (adding 0.38 QALYs and $37,768 incremental NMB), and EUS-CBD cost $17,694 (adding 0.55 QALYs and $52,171 incremental NMB). Although PTBD had the lowest cost, it was dominated due to fewer QALYs. Results were robust in sensitivity analyses.
CONCLUSION: EUS-GB and EUS-CBD are more cost-effective than PTBD for MDBO after failed ERCP. EUS-GB offers similar value to EUS-CBD, potentially with lower reintervention rates. Endoscopic management should be prioritized over PTBD for these patients.
METHODS: A decision analysis model compared costs and quality-adjusted life years (QALYs) over two years for patients with MDBO after failed ERCP, undergoing EUS-GB, EUS-CBD, or PTBD. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were calculated at a willingness-to-pay threshold of $100,000 per QALY. Probabilistic and deterministic sensitivity analyses were performed.
RESULTS: Both EUS-GB and EUS-CBD were more cost-effective than PTBD. PTBD cost $14,988, EUS-GB cost $14,520 (adding 0.38 QALYs and $37,768 incremental NMB), and EUS-CBD cost $17,694 (adding 0.55 QALYs and $52,171 incremental NMB). Although PTBD had the lowest cost, it was dominated due to fewer QALYs. Results were robust in sensitivity analyses.
CONCLUSION: EUS-GB and EUS-CBD are more cost-effective than PTBD for MDBO after failed ERCP. EUS-GB offers similar value to EUS-CBD, potentially with lower reintervention rates. Endoscopic management should be prioritized over PTBD for these patients.