Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis.

ABSTRACT

BACKGROUND: Controlled trials support pancreatic-stent placement as an effective intervention for the prevention of post-ERCP acute pancreatitis in high-risk patients. OBJECTIVE: To perform a decision analysis to evaluate the most cost-effective strategy for preventing post-ERCP pancreatitis. DESIGN: Cost-effectiveness analysis. SETTING: Patients undergoing ERCP. INTERVENTIONS: Three competing strategies were evaluated in a decision analysis model from a third-party-payer perspective in hypothetical patients undergoing ERCP. In strategy I, none of the patients had pancreatic-stent placement. Strategy II had only those patients identified to be at high risk for post-ERCP, and, in strategy III, all patients underwent prophylactic stent placement. Probabilities of developing post-ERCP pancreatitis and the risk reduction by placement of a pancreatic stent were obtained from published information. Cost estimates were obtained from Medicare reimbursement rates. MAIN OUTCOME MEASUREMENTS Incremental cost-effectiveness ratio (ICER) of different strategies. RESULTS: Strategy I was the least-expensive strategy but yielded the least number of life years. Strategy II yielded the highest number of years of life, with an ICER of $11,766 per year of life saved, and strategy III was dominated by strategy II. LIMITATIONS: Indirect costs and pharmacologic prophylaxis were not considered in this analysis. CONCLUSIONS: Pancreatic-stent placement for the prevention of post-ERCP pancreatitis in high-risk patients is a cost-effective strategy.