Abstract
Objective: Economic evaluation of early surgery compared to the endoscopy-first approach in CP. Background: In patients with painful CP and a dilated main pancreatic duct, early surgery, as compared with an endoscopy-first approach, leads to more pain reduction with fewer interventions. However, it is unknown if early surgery is more cost-effective than the endoscopy-first approach. Methods: The multicenter Dutch ESCAPE trial randomized patients with CP and a dilated main pancreatic duct between early surgery (surgery within 6 weeks) or the endoscopy-first approach in 30 centers (April 2011-September 2016). Healthcare utilization was prospectively recorded up to 18 months after randomization. Unit costs of resources were determined, and cost-effectiveness and cost-utility analyses were performed from societal and healthcare perspectives. Primary outcomes were the costs per unit decrease on the Izbicki pain score and per gained quality-adjusted life-year. Results: In total, 88 patients were included in the analysis, with 44 patients randomized to each group. Total costs were lower in the early surgery group but did not reach statistical significance (mean difference €-4,815 (95% bias-corrected and accelerated confidence interval €-13,113 to €-3411; P = 0.25). Early surgery had a probability percentage of 88.4% of being more cost-effective than the endoscopy-first approach at a willingness-to-pay threshold of €0 per day per unit decrease on the Izbicki pain score. The probability percentage per additional gained quality-adjusted life-year was 75.7% at a willingness-to-pay threshold of €-50,000. Conclusion: In patients with painful CP and a dilated main pancreatic duct, early surgery was more cost-effective than the endoscopy-first approach.
| Original language | English |
|---|---|
| Pages (from-to) | E878-E884 |
| Journal | Annals of Surgery |
| Volume | 277 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Apr 2023 |
Bibliographical note
Funding Information:Marja A. Boermeester and Marcel G. Dijkgraaf share senior authorship The Netherlands Organization for Health Research and Development (ZonMw, grant number 17110216), and the Dutch Digestive Diseases Foundation (grant number WO10-21, Maag Lever Darm Stichting) funded the ESCAPE trial. Both funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
Prof Bruno reports receiving institutional grants from Boston Scientific, personal fees from Boston Scientific, grants from Cook Medical, personal fees from Cook Medical, grants from Pentax Medical, personal fees from Pentax Medical, grants from 3 M, personal fees from 3 M, grants from Mylan, and personal fees from Mylan outside the submitted work.
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