Tu1536 Single-Operator Cholangioscopy Is More Cost-Effective Than Bile Duct Exploration for Management of Difficult Common Bile Duct Stones After Failed Conventional ERCP

Background and Aims: Single-operator cholangioscopy-assisted electrohydraulic lithotripsy (SOC-EHL) is effective and safe in difficult choledocholithiasis. The optimal timing of SOC-EHL use, however, in refractory stones has not been elucidated. The following aims to determine the most cost-effective timing of SOC-EHL introduction in the management of choledocholithiasis. Methods: A cost-effectiveness model was developed assessing three strategies with a progressively delayed introduction of SOC-EHL. Probability estimates of patient pathways were obtained from a systematic review. The unit of effectiveness is complete ductal clearance without need for surgery. Cost is expressed in 2018 US dollars and stem from outpatient US databases. Results: The three strategies achieved comparable ductal clearance rates ranging from 97.3% to 99.7%. The least expensive strategy is to perform SOC-EHL during the first endoscopic retrograde cholangiography pancreatography (ERCP) (SOC-1: 18,506$). The strategy of postponing the use of SOC-EHL to the third ERCP (SOC-3) is more expensive (US$18,895) but is 2% more effective. (0.9967). SOC-EHL during the second ERCP in the model (SOC-2) is the least cost-effective. Sensitivity analyses show altered conclusions according to the cost of SOC-EHL, effectiveness of conventional ERCP, and altered willingness-to-pay (WTP) thresholds with early SOC-1 being the most optimal approach below a WTP cut-off of US$20,295. Conclusions: Early utilization of SOC-EHL (SOC-1) in difficult choledocholithiasis may be the least costly strategy with an effectiveness approximating those achieved with a delayed approach where one or more conventional ERCP(s) are reattempted prior to SOC-EHL introduction.

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“…A total of 24 articles were used in the analysis with data abstracted from their full text. 10 , 23 – 45 …”

Section: Resultsmentioning

confidence: 99%

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Alrajhi

Barkun

Adam

et al. 2021

Therap Adv Gastroenterol

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Endoscopic management of biliary stone disease

Wilson

Webster

2017

Frontline Gastroenterol

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The management of bile duct stone disease is the most common indication for endoscopic retrograde cholangio-pancreatography (ERCP). The majority of cases may be resolved using standard approaches including endoscopic sphincterotomy and balloon stone extraction. Recent advances in the management of large or challenging stones has come from the clear evidence for the role of endoscopic papillary large balloon dilatation (EPLBD)/sphincteroplasty and the development of cholangioscopically directed lithotripsy. Perhaps the greatest improvement in endoscopic stone management will be achieved through the implementation of plans for more formalised training, reflection and audit of ERCP performance indicators and network-wide coordination of ERCP services.

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Tu1536 Single-Operator Cholangioscopy Is More Cost-Effective Than Bile Duct Exploration for Management of Difficult Common Bile Duct Stones After Failed Conventional ERCP

Cited by 2 publications

References 0 publications

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Endoscopic management of biliary stone disease

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