TY - JOUR
T1 - Endoscopic Ultrasonography-Guided Gastroenterostomy Is More Cost Effective Than Surgical Gastrojejunostomy
T2 - A Health-Economic Evaluation Alongside a Randomized Trial
AU - van de Pavert, Yorick L.
AU - Opmeer, Kirsten
AU - Dutch Pancreatic Cancer Group
AU - Besselink, Marc G.
AU - Bijlsma, Rina
AU - Booij, Dieke C.
AU - Boonstra, Jurjen J.
AU - Boot, Judith
AU - Bruno, Marco J.
AU - Busch, Olivier R.
AU - Daams, Freek
AU - Derksen, Wouter J.M.
AU - Fockens, Paul
AU - Kastelijn, Janine B.
AU - Koerkamp, Bas Groot
AU - Hagendoorn, Jeroen
AU - van Hooft, Jeanin E.
AU - Inderson, Akin
AU - Lammers, Willem J.
AU - Lips, Daan J.
AU - Mieog, J. Sven D.
AU - Molenaar, I. Quintus
AU - Veenhof, Alexander A.F.A.
AU - Venneman, Niels G.
AU - Verdonk, Robert C.
AU - Voermans, Rogier P.
AU - van Wanrooij, Roy L.J.
AU - Welsing, Paco M.J.
AU - de Wijkerslooth, Thomas R.
AU - van Santvoort, Hjalmar C.
AU - Moons, Leon M.G.
AU - van der Meulen, Miriam P.
AU - Vleggaar, Frank P.
N1 - Publisher Copyright:
© 2026 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
PY - 2026/6
Y1 - 2026/6
N2 - Background: There is a paucity of data on the cost-utility of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) compared with surgical gastrojejunostomy (SGJ) as palliative treatment of malignant gastric outlet obstruction. Methods:In the ENDURO trial, 98 patients with malignant gastric outlet obstruction from 12 Dutch hospitals were randomized between EUS-GE (N = 48) and SGJ (N = 50). Cost utility was evaluated from a healthcare perspective with a time horizon of 1 month. A bottom-up approach was used to calculate the costs of each intervention, including the per-minute price of the endoscopy and operating room (OR), considering personnel, construction, inventory and overhead costs. Other in-hospital costs were calculated using insurance claim data. Effectiveness was displayed as quality-adjusted life years (QALY). Bootstrapping was performed to estimate uncertainty. Results: The calculated per-minute price for the endoscopy room was €8.64 (US $9.34). The per-minute price for an OR was €11.78 (US $12.74). The mean intervention costs were estimated at €4405.40 (US $4762.68) for EUS-GE and €3393.71 (US $3668.93) for SGJ. Mean total in-hospital costs were lower following EUS-GE (€5172 [US $5591]) than after SGJ (€10,458 [US $11,306]), mainly due to a shorter length of hospital stay following EUS-GE. Bootstrapping showed that 99.9% of iterations resulted in lower costs for EUS-GE. Mean difference in 1-month QALY contribution was 0.004 in favor of EUS-GE. Most iterations fall within the bottom right quadrant (95.6%) of the cost-effectiveness plane, indicating lower costs and improved QALY contribution for EUS-GE. Discussion:In this study, EUS-GE was more cost effective than SGJ. The additional intervention costs were clearly outweighed by a decrease in in-hospital costs after the procedure.
AB - Background: There is a paucity of data on the cost-utility of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) compared with surgical gastrojejunostomy (SGJ) as palliative treatment of malignant gastric outlet obstruction. Methods:In the ENDURO trial, 98 patients with malignant gastric outlet obstruction from 12 Dutch hospitals were randomized between EUS-GE (N = 48) and SGJ (N = 50). Cost utility was evaluated from a healthcare perspective with a time horizon of 1 month. A bottom-up approach was used to calculate the costs of each intervention, including the per-minute price of the endoscopy and operating room (OR), considering personnel, construction, inventory and overhead costs. Other in-hospital costs were calculated using insurance claim data. Effectiveness was displayed as quality-adjusted life years (QALY). Bootstrapping was performed to estimate uncertainty. Results: The calculated per-minute price for the endoscopy room was €8.64 (US $9.34). The per-minute price for an OR was €11.78 (US $12.74). The mean intervention costs were estimated at €4405.40 (US $4762.68) for EUS-GE and €3393.71 (US $3668.93) for SGJ. Mean total in-hospital costs were lower following EUS-GE (€5172 [US $5591]) than after SGJ (€10,458 [US $11,306]), mainly due to a shorter length of hospital stay following EUS-GE. Bootstrapping showed that 99.9% of iterations resulted in lower costs for EUS-GE. Mean difference in 1-month QALY contribution was 0.004 in favor of EUS-GE. Most iterations fall within the bottom right quadrant (95.6%) of the cost-effectiveness plane, indicating lower costs and improved QALY contribution for EUS-GE. Discussion:In this study, EUS-GE was more cost effective than SGJ. The additional intervention costs were clearly outweighed by a decrease in in-hospital costs after the procedure.
UR - https://www.scopus.com/pages/publications/105041010069
U2 - 10.1002/ueg2.70220
DO - 10.1002/ueg2.70220
M3 - Article
C2 - 42247455
AN - SCOPUS:105041010069
SN - 2050-6406
VL - 14
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 5
M1 - e70220
ER -