Cost-Effectiveness of Modalities of Palliative Biliary Drainage in Malignant Extrahepatic Biliary Obstruction.

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.