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Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis.
Pancreas. 2015 Mar; 44(2):204-10.P

Abstract

OBJECTIVES

The aim of the present study was to perform a comparative cost-effectiveness analysis of the different strategies used to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis.

METHODS

We performed a cost-effectiveness decision analysis of 4 prophylactic strategies (nonsteroidal anti-inflammatory drugs or NSAIDs, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis) in a simulated cohort of 300 patients during 1 year. Treatment effectiveness was defined as the number of patients who did not develop post-ERCP pancreatitis.

RESULTS

The baseline costs of each strategy were as follows: rectal NSAID $359,098, pancreatic stent $426,504, stent plus rectal indomethacin $479,153, and no prophylaxis $491,275. The mean number of cases developing post-ERCP pancreatitis was 16, 21, 23, and 37 for the strategies rectal NSAID, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis, respectively. Taking rectal NSAID prophylaxis as the reference strategy, the odds ratio of an episode of post-ERCP acute pancreatitis after pancreatic stent placement was 1.33 (95% confidence interval [CI], 0.68-2.61); after stent plus indomethacin, it was 1.40 (95% CI, 0.72-2.73), and after no prophylaxis, it was 2.49 (95% CI, 1.35-4.59).

CONCLUSIONS

Rectal NSAID administration proved to be the most cost-effective prophylactic strategy used to prevent post-ERCP pancreatitis. The strategy of no prophylaxis for this complication should be avoided.

Authors+Show Affiliations

From the *Servicio de Aparato Digestivo, Hospital Universitario de Canarias, La Laguna, Tenerife; †Canary Islands Foundation for Health and Research (FUNCIS), Santa Cruz de Tenerife; ‡Health Services Research on Chronic Patients Network (REDISSEC); §Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife; ║Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife; and ¶Institute of Biomedical Technologies and Center of Biomedical Research of the Canary Islands (CIBICAN), La Laguna University, Tenerife, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25406954

Citation

Nicolás-Pérez, David, et al. "Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Cost-effectiveness Analysis." Pancreas, vol. 44, no. 2, 2015, pp. 204-10.
Nicolás-Pérez D, Castilla-Rodríguez I, Gimeno-García AZ, et al. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis. Pancreas. 2015;44(2):204-10.
Nicolás-Pérez, D., Castilla-Rodríguez, I., Gimeno-García, A. Z., Romero-García, R., Núñez-Díaz, V., & Quintero, E. (2015). Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis. Pancreas, 44(2), 204-10. https://doi.org/10.1097/MPA.0000000000000245
Nicolás-Pérez D, et al. Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: a Cost-effectiveness Analysis. Pancreas. 2015;44(2):204-10. PubMed PMID: 25406954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis. AU - Nicolás-Pérez,David, AU - Castilla-Rodríguez,Iván, AU - Gimeno-García,Antonio Z, AU - Romero-García,Rafael, AU - Núñez-Díaz,Venancio, AU - Quintero,Enrique, PY - 2014/11/20/entrez PY - 2014/11/20/pubmed PY - 2015/12/15/medline SP - 204 EP - 10 JF - Pancreas JO - Pancreas VL - 44 IS - 2 N2 - OBJECTIVES: The aim of the present study was to perform a comparative cost-effectiveness analysis of the different strategies used to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis. METHODS: We performed a cost-effectiveness decision analysis of 4 prophylactic strategies (nonsteroidal anti-inflammatory drugs or NSAIDs, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis) in a simulated cohort of 300 patients during 1 year. Treatment effectiveness was defined as the number of patients who did not develop post-ERCP pancreatitis. RESULTS: The baseline costs of each strategy were as follows: rectal NSAID $359,098, pancreatic stent $426,504, stent plus rectal indomethacin $479,153, and no prophylaxis $491,275. The mean number of cases developing post-ERCP pancreatitis was 16, 21, 23, and 37 for the strategies rectal NSAID, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis, respectively. Taking rectal NSAID prophylaxis as the reference strategy, the odds ratio of an episode of post-ERCP acute pancreatitis after pancreatic stent placement was 1.33 (95% confidence interval [CI], 0.68-2.61); after stent plus indomethacin, it was 1.40 (95% CI, 0.72-2.73), and after no prophylaxis, it was 2.49 (95% CI, 1.35-4.59). CONCLUSIONS: Rectal NSAID administration proved to be the most cost-effective prophylactic strategy used to prevent post-ERCP pancreatitis. The strategy of no prophylaxis for this complication should be avoided. SN - 1536-4828 UR - https://www.unboundmedicine.com/medline/citation/25406954/Prevention_of_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis:_a_cost_effectiveness_analysis_ L2 - https://doi.org/10.1097/MPA.0000000000000245 DB - PRIME DP - Unbound Medicine ER -