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Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis
  1. Philippe Laramée1,
  2. David Wonderling1,
  3. Djuna L Cahen2,
  4. Marcel G Dijkgraaf3,
  5. Dirk J Gouma4,
  6. Marco J Bruno2,
  7. Stephen P Pereira5
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London, UK
  2. 2Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  5. 5UCL Institute for Liver and Digestive Health, University College London, London, UK
  1. Correspondence to Dr Stephen P Pereira; Stephen.pereira{at}ucl.ac.uk

Abstract

Objective Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis.

Design This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis.

Setting Hospital.

Participants Patients with obstructive chronic pancreatitis.

Primary and secondary outcome measures Costs, QALYs and cost-effectiveness.

Results The result of the base-case analysis was that surgical drainage dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the surgical option remained dominant in all scenarios. The probability of cost-effectiveness for surgical drainage was 100% for the base case and 82% in the assessed most conservative case scenario.

Conclusions In obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared with endoscopic drainage from a UK NHS perspective.

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