title: Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis.
abstract: OBJECTIVE
  The aim of the present study was to perform a comparative cost-effectiveness analysis of the different strategies used to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis.
  
  
  METHODS
  We performed a cost-effectiveness decision analysis of 4 prophylactic strategies (nonsteroidal anti-inflammatory drugs or NSAIDs, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis) in a simulated cohort of 300 patients during 1 year. Treatment effectiveness was defined as the number of patients who did not develop post-ERCP pancreatitis.
  
  
  RESULTS
  The baseline costs of each strategy were as follows: rectal NSAID $359,098, pancreatic stent $426,504, stent plus rectal indomethacin $479,153, and no prophylaxis $491,275. The mean number of cases developing post-ERCP pancreatitis was 16, 21, 23, and 37 for the strategies rectal NSAID, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis, respectively. Taking rectal NSAID prophylaxis as the reference strategy, the odds ratio of an episode of post-ERCP acute pancreatitis after pancreatic stent placement was 1.33 (95% confidence interval [CI], 0.68-2.61); after stent plus indomethacin, it was 1.40 (95% CI, 0.72-2.73), and after no prophylaxis, it was 2.49 (95% CI, 1.35-4.59).
  
  
  CONCLUSIONS
  Rectal NSAID administration proved to be the most cost-effective prophylactic strategy used to prevent post-ERCP pancreatitis. The strategy of no prophylaxis for this complication should be avoided.
authors.affiliation: From the *Servicio de Aparato Digestivo, Hospital Universitario de Canarias, La Laguna, Tenerife; †Canary Islands Foundation for Health and Research (FUNCIS), Santa Cruz de Tenerife; ‡Health Services Research on Chronic Patients Network (REDISSEC); §Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife; ║Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife; and ¶Institute of Biomedical Technologies and Center of Biomedical Research of the Canary Islands (CIBICAN), La Laguna University, Tenerife, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Nicolás-Pérez
authors.forename: Iván
authors.initials: I
authors.lastname: Castilla-Rodríguez
authors.forename: Antonio Z
authors.initials: AZ
authors.lastname: Gimeno-García
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero-García
authors.forename: Venancio
authors.initials: V
authors.lastname: Núñez-Díaz
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
mesh_terms: D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000191:economics*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D004008:Diclofenac / Q000008:administration & dosage / Q000191:economics; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D016017:Odds Ratio; D010195:Pancreatitis / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D015607:Stents / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D007213:Indomethacin