Clinical and translational gastroenterology · 2026
Cost-Effectiveness of Modalities of Palliative Biliary Drainage in Malignant Extrahepatic Biliary Obstruction.
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Abbasi Abdullah, Menon Shyam
Аннотация
INTRODUCTION: Biliary drainage in malignant extrahepatic distal bile duct obstruction can be achieved with endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), or endoscopic ultrasound-assisted choledochoduodenostomy (EUS-CDS). The aim of our study was to evaluate all these modalities in a cost-effective model.
METHODS: A patient level discrete time cycle Markov model was developed using United Kingdom's healthcare resource group tariff costs. Health-related quality of life data were used to develop quality-adjusted life years. Monte-Carlo deterministic analysis was performed. Probabilistic sensitivity analysis and deterministic analysis were performed.
RESULTS: EUS-CDS was the most cost-effective modality for biliary drainage in malignant extrahepatic distal bile duct obstruction (cost £2,116 [$2,853.99]/effectiveness 1.35) compared with ERCP (£2,349 [$3,168.25]/1.33) and PTBD (£3,161 [$4,263.45]/1.31). Microsimulation over 1,000 patient iterations confirmed that EUS-CDS had the highest net monetary benefit.
DISCUSSION: EUS-CDS seems to be a cost-effective strategy for biliary drainage in malignant obstruction under a range of modeling assumptions, particularly in settings with adequate availability and expertise.
METHODS: A patient level discrete time cycle Markov model was developed using United Kingdom's healthcare resource group tariff costs. Health-related quality of life data were used to develop quality-adjusted life years. Monte-Carlo deterministic analysis was performed. Probabilistic sensitivity analysis and deterministic analysis were performed.
RESULTS: EUS-CDS was the most cost-effective modality for biliary drainage in malignant extrahepatic distal bile duct obstruction (cost £2,116 [$2,853.99]/effectiveness 1.35) compared with ERCP (£2,349 [$3,168.25]/1.33) and PTBD (£3,161 [$4,263.45]/1.31). Microsimulation over 1,000 patient iterations confirmed that EUS-CDS had the highest net monetary benefit.
DISCUSSION: EUS-CDS seems to be a cost-effective strategy for biliary drainage in malignant obstruction under a range of modeling assumptions, particularly in settings with adequate availability and expertise.