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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(09): E1193-E1200
DOI: 10.1055/a-1873-0884
Original article

Cost-effective analysis of preliminary single-operator cholangioscopy for management of difficult biliary stones

Igor Sljivic
1   Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
,
Roberto Trasolini
2   Division of Gastroenterology, Hepatology and Endoscopy, Harvard University, Cambridge, Massachusetts, United States
,
Fergal Donnellan
3   Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
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Abstract

Background and study aims Single-operator peroral cholangioscopy (SOC) is a therapeutic modality for difficult biliary stone disease. Given its high success rate and increasing availability, analysis of the economic impact of early SOC utilization is critical for clinical decision-making. Our aim is to compare the cost-effectiveness of different first and second-line endoscopic modalities for difficult-to-treat choledocholithiasis.

Patients and methods A decision-tree model with a 1-year time horizon and a hypothetical cohort of 200 patients was used to analyze the cost-effectiveness of SOC for first, second and third-line intervention in presumed difficult biliary stones. We adopted the perspective of a Canadian tertiary hospital, omitting recurrence rates associated with endoscopic retrograde cholangiopancreatography (ERCP). Effectiveness estimates were obtained from updated meta-analyses. One-way sensitivity analyses and probabilistic sensitivity analyses were also performed to assess how changes in key parameters affected model conclusions.

Results First- and second-line SOC achieved comparable clinical efficacy from 96.3 % to 97.6% stone clearance. The least expensive strategy is third-line SOC (SOC-3: $800,936). Performing SOC during the second ERCP was marginally more expensive (SOC-2: $ 816,584) but 9 % more effective. The strategy of first-line SOC incurred the highest hospital expenditures (SOC-1: $ 851,457) but decreased total procedures performed by 16.9 % when compared with SOC-2. Sensitivity analysis was robust in showing SOC-2 as the most optimal approach.

Conclusions Second-line SOC was superior to first and third-line SOC for treatment of difficult biliary stones. When based on meta-analysis of non-heterogeneous trials, SOC-2 is more cost-effective and cost-efficient. Our study warrants a larger pragmatic effectiveness trial.



Publication History

Received: 01 October 2021

Accepted after revision: 08 June 2022

Accepted Manuscript online:
09 June 2022

Article published online:
14 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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