Prophylactic clipping versus no clipping after endoscopic mucosal resection of large nonpedunculated colon polyps: a cost-effectiveness analysis.

BACKGROUND AND AIMS: Delayed postpolypectomy bleeding (DPPB) is an established adverse event after EMR of large nonpedunculated colon polyps (LNPCPs). Although clipping is commonly used in clinical settings, particularly for LNPCPs and for patients on antithrombotic agents, the cost-effectiveness of prophylactic clipping is not well studied.

METHODS

We conducted an incremental cost-effectiveness analysis comparing prophylactic clipping (PC) versus no clipping (NC) for DPPB over a 1-year time horizon using a Markov decision tree model based on pooled randomized controlled trial data. Costs for hemostatic clips, hospitalization, and EMR were derived from Centers for Medicare & Medicaid Services reimbursement data and published literature. Analysis was performed by using TreeAge Pro Healthcare 2024.

RESULTS

Pooled data from 4557 patients (2288 PC; 2269 NC) were analyzed. For a base case of a 65-year-old patient undergoing EMR of ≥20 mm proximal LNPCP, PC resulted in an incremental cost-effectiveness ratio (ICER) of -$154,706, indicating cost savings. For very large (≥40 mm) LNPCPs, PC was cost-effective compared with NC, with an ICER of $83,894. Among patients with LNPCPs on antithrombotic therapy, PC was cost-saving when up to 2 clips were used, with an ICER of -$120,561. For proximal LNPCPs, PC remains cost-effective when per-clip cost is below $217 or <4 clips are used.

CONCLUSIONS

At a willingness-to-pay threshold of $100,000 dollars per quality-adjusted life year, PC is cost-saving for proximal LNPCPs, cost-effective for very large (≥40 mm) LNPCPs, and cost-saving for patients with LNPCPs on antithrombotic agents. Reducing clip costs (≤$217) and optimizing usage (≤4 clips) further improve economic viability of PC.