Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis.
BACKGROUND
Controlled trials support pancreatic-stent placement as an effective intervention for the prevention of post-ERCP acute pancreatitis in high-risk patients.


OBJECTIVE
To perform a decision analysis to evaluate the most cost-effective strategy for preventing post-ERCP pancreatitis.


METHODS
Cost-effectiveness analysis.


METHODS
Patients undergoing ERCP.


METHODS
Three competing strategies were evaluated in a decision analysis model from a third-party-payer perspective in hypothetical patients undergoing ERCP. In strategy I, none of the patients had pancreatic-stent placement. Strategy II had only those patients identified to be at high risk for post-ERCP, and, in strategy III, all patients underwent prophylactic stent placement. Probabilities of developing post-ERCP pancreatitis and the risk reduction by placement of a pancreatic stent were obtained from published information. Cost estimates were obtained from Medicare reimbursement rates.


METHODS
Incremental cost-effectiveness ratio (ICER) of different strategies.


RESULTS
Strategy I was the least-expensive strategy but yielded the least number of life years. Strategy II yielded the highest number of years of life, with an ICER of $11,766 per year of life saved, and strategy III was dominated by strategy II.


CONCLUSIONS
Indirect costs and pharmacologic prophylaxis were not considered in this analysis.


CONCLUSIONS
Pancreatic-stent placement for the prevention of post-ERCP pancreatitis in high-risk patients is a cost-effective strategy.
Das
Ananya
A
Division of Gastroenterology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
Singh
Pankaj
P
Sivak
Michael V
MV
Chak
Amitabh
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009010:Monte Carlo Method; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D019919:Prosthesis Implantation / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D046628:Sphincter of Oddi Dysfunction / Q000175:diagnosis; D015607:Stents