title: Cost utility analysis of endoscopic biliary stent in unresectable hilar cholangiocarcinoma: decision analytic modeling approach.
abstract: OBJECTIVE
  Endoscopic biliary drainage using metal and plastic stent in unresectable hilar cholangiocarcinoma (HCA) is widely used but little is known about their cost-effectiveness. This study evaluated the cost-utility of endoscopic metal and plastic stent drainage in unresectable complex, Bismuth type II-IV, HCA patients.
  
  
  METHODS
  Decision analytic model, Markov model, was used to evaluate cost and quality-adjusted life year (QALY) of endoscopic biliary drainage in unresectable HCA. Costs of treatment and utilities of each Markov state were retrieved from hospital charges and unresectable HCA patients from tertiary care hospital in Thailand, respectively. Transition probabilities were derived from international literature. Base case analyses and sensitivity analyses were performed.
  
  
  RESULTS
  Under the base-case analysis, metal stent is more effective but more expensive than plastic stent. An incremental cost per additional QALY gained is 192,650 baht (US$ 6,318). From probabilistic sensitivity analysis, at the willingness to pay threshold of one and three times GDP per capita or 158,000 baht (US$ 5,182) and 474,000 baht (US$ 15,546), the probability of metal stent being cost-effective is 26.4% and 99.8%, respectively.
  
  
  CONCLUSIONS
  Based on the WHO recommendation regarding the cost-effectiveness threshold criteria, endoscopic metal stent drainage is cost-effective compared to plastic stent in unresectable complex HCA.
authors.forename: Apichat
authors.initials: A
authors.lastname: Sangchan
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.forename: Siripen
authors.initials: S
authors.lastname: Supakankunti
authors.forename: Ake
authors.initials: A
authors.lastname: Pugkhem
authors.forename: Pisaln
authors.initials: P
authors.lastname: Mairiang
mesh_terms: D001650:Bile Duct Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004322:Drainage / Q000191:economics* / Q000295:instrumentation; D004724:Endoscopy / Q000191:economics* / Q000295:instrumentation; D017048:Health Care Costs; D017722:Hospital Charges; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008670:Metals; D018803:Models, Economic; D010969:Plastics; D011336:Probability; D011474:Prosthesis Design; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics*; D062606:Tertiary Care Centers / Q000191:economics; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics