Cost-effective analysis of preliminary single-operator cholangioscopy for management of difficult biliary stones

Background and study aims: Single-operator peroral cholangioscopy (SOC) is a therapeutic modality for difficult biliary stone disease. Given its high success rate and increasing availability, analysis of the economic impact of early SOC utilisation is critical for clinical decision-making. Our aim is to compare the cost-effectiveness of different first and second-line endoscopic modalities for difficult-to-treat choledocholithiasis. Patients and methods: A decision tree model with a 1-year time horizon and a hypothetical cohort of 200 patients was used to analyze the cost-effectiveness of SOC for first, second and third-line intervention in presumed difficult biliary stones. We adopted the perspective of a Canadian tertiary hospital, omitting recurrence rates associated with ERCP. Effectiveness estimates were obtained from updated meta-analyses. One-way sensitivity analyses and probabilistic sensitivity analyses were also performed to assess how changes in key parameters affected model conclusions. Results: First and second line SOC achieved comparable clinical efficacy from 96.3% to 97.6% stone clearance. The least expensive strategy is third-line SOC (SOC-3: $800,936). Performing SOC during the second ERCP was marginally more expensive (SOC-2: $816,584) but 9% more effective. The strategy of first-line SOC incurred the highest hospital expenditures (SOC-1: $851,457) but decreased total procedures performed by 16.9% when compared with SOC-2. Sensitivity analysis was robust in showing SOC-2 as the most optimal approach. Conclusions: Second-line SOC was superior to first and third-line SOC for treatment of difficult biliary stones. When based on meta-analysis of non-heterogeneous trials, SOC-2 is more cost-effective and cost-efficient. Our study warrants a larger pragmatic effectiveness trial.

Angaben zum Objekt

• Standort: Deutsche Nationalbibliothek Frankfurt am Main
• Umfang: Online-Ressource
• Sprache: Englisch

Verweise und Beziehungen

• Erschienen in: Cost-effective analysis of preliminary single-operator cholangioscopy for management of difficult biliary stones ; day:09 ; month:06 ; year:2022 ; Endoscopy International Open ; (09.06.2022)

Beteiligte, Orts- und Zeitangaben

• Beteiligte Personen und Organisationen: Sljivic, Igor ; Trasolini, Roberto ; Donnellan, Fergal

Weitere Informationen

• DOI: 10.1055/a-1873-0884
• URN: urn:nbn:de:101:1-2022072809092041746014
• Rechteinformation: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Letzte Aktualisierung: 15.08.2025, 07:28 MESZ