医学
内窥镜检查
随机对照试验
置信区间
随机化
外科
质量调整寿命年
胰腺炎
生活质量(医疗保健)
成本效益
内科学
风险分析(工程)
护理部
作者
Marinus A. Kempeneers,Yama Issa,Marco J. Bruno,Hjalmar C. van Santvoort,Marc G. Besselink,Marja A. Boermeester,Marcel G. W. Dijkgraaf
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2021-10-08
卷期号:277 (4): e878-e884
被引量:2
标识
DOI:10.1097/sla.0000000000005240
摘要
Economic evaluation of early surgery compared to the endoscopy-first approach in CP.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.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.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.In patients with painful CP and a dilated main pancreatic duct, early surgery was more cost-effective than the endoscopy-first approach.
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