The Answer to 'When to Clip' After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis
| العنوان: | The Answer to 'When to Clip' After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis |
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| المؤلفون: | Mónica Enguita-Germán, Marco Antonio Alvarez-Gonzalez, Alberto Herreros de Tejada, Cesare Hassan, Pedro Rosón, Antonio Z. Gimeno-García, Óscar Nogales, Carlos Guarner, Eduardo Albéniz, Jorge C. Espinós, Alessandro Repici, Joaquín Rodríguez Sánchez, Pradeep Bhandari, Berta Ibáñez Beroiz, Marco Spadaccini, José Carlos Marín |
| المصدر: | AMERICAN JOURNAL OF GASTROENTEROLOGY r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| بيانات النشر: | LIPPINCOTT WILLIAMS & WILKINS, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Endoscopic Mucosal Resection, Cost-Benefit Analysis, Population, Context (language use), Endoscopic mucosal resection, Postoperative Hemorrhage, law.invention, 03 medical and health sciences, Polyps, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, education, health care economics and organizations, Aged, Aged, 80 and over, education.field_of_study, Framingham Risk Score, Hepatology, Wound Closure Techniques, business.industry, Gastroenterology, Colonoscopy, Cost-effectiveness analysis, Middle Aged, Surgical Instruments, Tumor Burden, Surgery, Quality-adjusted life year, Spain, 030220 oncology & carcinogenesis, Relative risk, Female, 030211 gastroenterology & hepatology, Quality-Adjusted Life Years, Colorectal Neoplasms, business |
| الوصف: | INTRODUCTION: Delayed bleeding (DB) is the most common major complication of endoscopic mucosal resection (EMR). Two randomized clinical trials recently demonstrated that clip closure after EMR of large nonpedunculated colorectal polyps (LNPCPs) reduces the risk of DB. We analyzed the cost-effectiveness of this prophylactic measure. METHODS: EMRs of LNCPCPs were consecutively registered in the ongoing prospective multicenter database of the Spanish EMR Group from May 2013 until July 2017. Patients were classified according to the Spanish Endoscopy Society EMR group (GSEED-RE2) DB risk score. Cost-effectiveness analysis was performed for both Spanish and US economic contexts. The average incremental cost-effectiveness ratio (ICER) thresholds were set at 54,000 euro or $100,000 per quality-adjusted life year, respectively. RESULTS: We registered 2,263 EMRs in 2,130 patients. Applying their respective DB relative risk reductions after clip closure (51% and 59%), the DB rate decreased from 4.5% to 2.2% in the total cohort and from 13.7% to 5.7% in the high risk of the DB GSEED-RE2 subgroup. The ICERs for the universal clipping strategy in Spain and the United States, 469,706 euro and $1,258,641, respectively, were not cost effective. By contrast, selective clipping in the high-risk of DB GSEED-RE2 subgroup was cost saving, with a negative ICER of -2,194 euro in the Spanish context and cost effective with an ICER of $87,796 in the United States. DISCUSSION: Clip closure after EMR of large colorectal lesions is cost effective in patients with a high risk of bleeding. The GSEED-RE2 DB risk score may be a useful tool to identify that high-risk population. |
| تدمد: | 0002-9270 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::03e7095dd3e8a2ab507338300cbc6b2b https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=5041 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....03e7095dd3e8a2ab507338300cbc6b2b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00029270 |
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