Endoscopic Ultrasonography-Guided Gastroenterostomy Is More Cost Effective Than Surgical Gastrojejunostomy: A Health-Economic Evaluation Alongside a Randomized Trial.
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van de Pavert Yorick L, Opmeer Kirsten, Besselink Marc G, Bijlsma Rina, Booij Dieke C, Boonstra Jurjen J, Boot Judith, Bruno Marco J, Busch Olivier R, Daams Freek, Derksen Wouter J M, Fockens Paul, Kastelijn Janine B, Koerkamp Bas Groot, Hagendoorn Jeroen, van Hooft Jeanin E, Inderson Akin, Lammers Willem J, Lips Daan J, Mieog J Sven D, Molenaar I Quintus, Veenhof Alexander A F A, Venneman Niels G, Verdonk Robert C, Voermans Rogier P, van Wanrooij Roy L J, Welsing Paco M J, de Wijkerslooth Thomas R, van Santvoort Hjalmar C, Moons Leon M G, van der Meulen Miriam P, Vleggaar Frank P, Dutch Pancreatic Cancer Group
Аннотация
METHODS: In the ENDURO trial, 98 patients with malignant gastric outlet obstruction from 12 Dutch hospitals were randomized between EUS-GE (N = 48) and SGJ (N = 50). Cost utility was evaluated from a healthcare perspective with a time horizon of 1 month. A bottom-up approach was used to calculate the costs of each intervention, including the per-minute price of the endoscopy and operating room (OR), considering personnel, construction, inventory and overhead costs. Other in-hospital costs were calculated using insurance claim data. Effectiveness was displayed as quality-adjusted life years (QALY). Bootstrapping was performed to estimate uncertainty.
RESULTS: The calculated per-minute price for the endoscopy room was €8.64 (US $9.34). The per-minute price for an OR was €11.78 (US $12.74). The mean intervention costs were estimated at €4405.40 (US $4762.68) for EUS-GE and €3393.71 (US $3668.93) for SGJ. Mean total in-hospital costs were lower following EUS-GE (€5172 [US $5591]) than after SGJ (€10,458 [US $11,306]), mainly due to a shorter length of hospital stay following EUS-GE. Bootstrapping showed that 99.9% of iterations resulted in lower costs for EUS-GE. Mean difference in 1-month QALY contribution was 0.004 in favor of EUS-GE. Most iterations fall within the bottom right quadrant (95.6%) of the cost-effectiveness plane, indicating lower costs and improved QALY contribution for EUS-GE.
DISCUSSION: In this study, EUS-GE was more cost effective than SGJ. The additional intervention costs were clearly outweighed by a decrease in in-hospital costs after the procedure.