Cost-Effectiveness of Modalities of Palliative Biliary Drainage in Malignant Extrahepatic Biliary Obstruction.

IF 3.6 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Translational Gastroenterology Pub Date : 2026-09-01 Epub Date: 2026-07-06 DOI:10.14309/ctg.0000000000001062

Abdullah Abbasi, Shyam Menon

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引用次数: 0

Abstract

Introduction: Biliary drainage in malignant extrahepatic distal bile duct obstruction can be achieved with endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), or endoscopic ultrasound-assisted choledochoduodenostomy (EUS-CDS). The aim of our study was to evaluate all these modalities in a cost-effective model.

Methods: A patient level discrete time cycle Markov model was developed using United Kingdom's healthcare resource group tariff costs. Health-related quality of life data were used to develop quality-adjusted life years. Monte-Carlo deterministic analysis was performed. Probabilistic sensitivity analysis and deterministic analysis were performed.

Results: EUS-CDS was the most cost-effective modality for biliary drainage in malignant extrahepatic distal bile duct obstruction (cost £2,116 [$2,853.99]/effectiveness 1.35) compared with ERCP (£2,349 [$3,168.25]/1.33) and PTBD (£3,161 [$4,263.45]/1.31). Microsimulation over 1,000 patient iterations confirmed that EUS-CDS had the highest net monetary benefit.

Discussion: EUS-CDS seems to be a cost-effective strategy for biliary drainage in malignant obstruction under a range of modeling assumptions, particularly in settings with adequate availability and expertise.

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恶性肝外胆道梗阻姑息性胆道引流方式的成本效益分析。

导言：恶性肝外远端胆管梗阻（MBO）的胆道引流可以通过内镜逆行胆管造影（ERCP）、经皮经肝胆道引流（PTBD）或内镜超声辅助胆总管十二指肠吻合术（EUS-CDS）来实现。我们研究的目的是在一个具有成本效益的模型中评估所有这些模式。方法：采用英国医疗资源组（HRG）收费成本建立患者水平离散时间周期马尔可夫模型。健康相关生活质量（HRQoL）数据用于制定质量调整生命年（QALYs）。进行蒙特卡罗确定性分析。进行了概率敏感性分析和确定性分析。结果：EUS-CDS是MBO患者最具成本效益的胆道引流方式，（成本2,116英镑（2,853.99美元）/有效性1.35），而ERCP（2,349英镑（3,168.25美元）/ 1.33）和PTBD（3,161英镑（4,263.45美元）/ 1.31）。超过1000例患者迭代的微观模拟证实了EUS-CDS具有最高的净货币效益。结论：在一系列模型假设下，EUS-CDS似乎是恶性梗阻胆道引流的成本效益策略，特别是在具有足够可用性和专业知识的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.00

自引率

0.00%

发文量

114

审稿时长

16 weeks

期刊介绍： Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.