title: Cost comparison of endoscopic stenting vs surgical treatment for unresectable cholangiocarcinoma.
abstract: BACKGROUND
  Total lifetime costs of endoscopic vs surgical treatment for obstructive jaundice due to cholangiocarcinoma are difficult to assess. The purpose of this study was to compare total costs in these two groups, including all treatment and retreatments.
  
  
  METHODS
  This retrospective study identified patients with biopsy-proven cholangiocarcinoma treated this decade with either endoscopic biliary stenting or surgical biliary-enteric bypass with or without resection. Outcomes and hospital charges were recorded. Ten matched control patients were compared from each group. Costs included those for cost of repeat endoscopy in the endoscopic group and for the management of recurrent obstructive jaundice in the surgical group.
  
  
  RESULTS
  The groups were similar in age and gender ratio. The surgical approach was frequently for cure; therefore, surgical patients were by and large at an earlier stage of their disease than those in the endoscopic group. Mean survival for the endoscopic group was 19 months vs 16.5 months for the surgical group. The median total lifetime cost for surgical therapy was $60,986 vs $24,251 for endoscopic therapy.
  
  
  CONCLUSIONS
  Endoscopic therapy is an effective palliative therapy for unresectable cholangiocarcinoma. Endoscopic therapy for this entity costs significantly less than surgical treatment. The cost benefit of endoscopic stenting over standard surgical bypass in the management of patients with unresectable cholangiocarcinoma, when considered along with its minimally invasive approach, makes this the procedure of choice for palliative therapy.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: R C G
authors.initials: RC
authors.lastname: Martin
authors.forename: G C
authors.initials: GC
authors.lastname: Vitale
authors.forename: D N
authors.initials: DN
authors.lastname: Reed
authors.forename: G M
authors.initials: GM
authors.lastname: Larson
authors.forename: M J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: K M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000191:economics / Q000379:methods; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics* / Q000379:methods; D002779:Cholestasis / Q000191:economics / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D003135:Common Bile Duct / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy / Q000191:economics / Q000379:methods; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*; D017211:Treatment Failure