Cost‐effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection

2021 ◽  
Author(s):  
Masau Sekiguchi ◽  
Ataru Igarashi ◽  
Yasuhiko Mizuguchi ◽  
Hiroyuki Takamaru ◽  
Masayoshi Yamada ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Cost Effectiveness Analysis ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Effectiveness Analysis ◽  
Laterally Spreading Tumors

Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

Gut ◽  
2017 ◽  
Vol 67 (11) ◽  
pp. 1965-1973 ◽  
Author(s):  
Farzan F Bahin ◽  
Steven J Heitman ◽  
Khalid N Rasouli ◽  
Hema Mahajan ◽  
Duncan McLeod ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Submucosal Dissection ◽  
Incremental Cost ◽  
Endoscopic Mucosal Resection ◽  
Cost Effectiveness Analysis ◽  
Wide Field ◽  
Tree Model ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Effectiveness Analysis

ObjectiveTo compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm.DesignAn incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed.Results1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions.ConclusionS-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs.Trial registration numberNCT02000141.

The Answer to “When to Clip” After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eduardo Albéniz ◽  
Mónica Enguita-Germán ◽  
Antonio Zebenzuy Gimeno-García ◽  
Alberto Herreros de Tejada ◽  
Oscar Nogales ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Mucosal Resection ◽  
Cost Effectiveness Analysis ◽  
Mucosal Resection ◽  
Effectiveness Analysis
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