Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis

Dhairya Mehta; Adam H. Loutfy; Vladimir M. Kushnir; Ashley L. Faulx; Zachary L. Smith

doi:10.1055/a-1469-2644

Endoscopy, Inhaltsverzeichnis

Endoscopy 2022; 54(04): 367-375
DOI: 10.1055/a-1469-2644

Original article

Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis

Dhairya Mehta

¹Department of Medicine, University Hospitals, Cleveland, Ohio, USA

²Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA

³Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA

,

Adam H. Loutfy

¹Department of Medicine, University Hospitals, Cleveland, Ohio, USA

,

Vladimir M. Kushnir

⁴Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA

,

Ashley L. Faulx

¹Department of Medicine, University Hospitals, Cleveland, Ohio, USA

²Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA

,

Zachary L. Smith

¹Department of Medicine, University Hospitals, Cleveland, Ohio, USA

²Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA

⁵Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

› Institutsangaben

Abstract

Background For large sessile colorectal polyps (LSCPs), endoscopic mucosal resection without diathermy (“cold endoscopic mucosal resection [EMR]”) is gaining popularity because of its safety advantages over conventional EMR (“hot EMR”). Polyp recurrence rates have been reported to be higher with cold EMR. Considering these differences, we performed a cost-effectiveness analysis of these two techniques.

Methods A decision analysis model was constructed for EMR of an LSCP. The decision tree incorporated the EMR method, clip use, procedural mortality, adverse events and their management, and polyp recurrence. Outcomes included days of lost productivity and marginal cost difference. Adverse event and recurrence rates were extracted from the existing literature, giving emphasis to recent systematic reviews and randomized controlled trials.

Results Through 30 months of follow-up, the average cost of removing an LSCP by cold EMR was US$5213, as compared to $6168 by hot EMR, yielding a $955 cost difference (95 % confidence interval $903–$1006). Average days of lost productivity were 6.2 days for cold EMR and 6.3 days for hot EMR. This cost advantage remained over several analyses accounting for variations in recurrence rates and clip closure strategies. Clip cost and LSCP recurrence rate had the greatest and the least impacts on the marginal cost difference, respectively.

Conclusion Cold EMR is the dominant strategy over hot EMR, with lower cost and fewer days of lost productivity. In theory, a complete transition to cold EMR for LSCPs in the USA could result in an annual cost saving approaching US$7 million to Medicare beneficiaries.

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Referenzen

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