PMID- 27590963
OWN - NLM
STAT- MEDLINE
DCOM- 20171011
LR  - 20240507
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 85
IP  - 4
DP  - 2017 Apr
TI  - Cost utility of ERCP-based modalities for the diagnosis of cholangiocarcinoma in 
      primary sclerosing cholangitis.
PG  - 773-781.e10
LID - S0016-5107(16)30526-0 [pii]
LID - 10.1016/j.gie.2016.08.020 [doi]
AB  - BACKGROUND AND AIMS: Cholangiocarcinoma (CCA) is a leading cause of morbidity and 
      mortality in patients with primary sclerosing cholangitis (PSC). Although several 
      ERCP-based diagnostic modalities are available for diagnosing CCA, it is unclear 
      whether one modality is more cost-effective than the others. The primary aim of 
      this study was to compare the cost-effectiveness of ERCP-based techniques for 
      diagnosing CCA in patients with PSC-induced biliary strictures. METHODS: We 
      performed a cost utility analysis to assess the net monetary benefit for 
      accurately diagnosing CCA using 5 different diagnostic strategies: (1) ERCP with 
      bile duct brushing for cytology, (2) ERCP with brushings for cytology and 
      fluorescence in situ hybridization (FISH)-trisomy, (3) ERCP with brushings for 
      cytology and FISH-polysomy, (4) ERCP with intraductal biopsy sampling, and (5) 
      single-operator cholangioscopy (SOC) with targeted biopsy sampling. A Monte Carlo 
      simulation assessed outcomes including quality-adjusted life years (QALYs) and 
      the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also 
      performed. RESULTS: SOC with targeted biopsy sampling, as compared with ERCP with 
      brushing for FISH-polysomy, produced an incremental QALY gain of .22 at an 
      additional cost of $8562.44, resulting in a base case ICER of $39,277.25. 
      Deterministic and probabilistic sensitivity analyses demonstrated that diagnosis 
      with SOC was cost-effective at conventional willingness-to-pay thresholds of 
      $50,000 and $100,000. SOC was the most cost-effective diagnostic strategy. 
      CONCLUSIONS: SOC with biopsy sampling is the most cost-effective diagnostic 
      modality for CCA in PSC strictures.
CI  - Copyright (c) 2017 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Njei, Basile
AU  - Njei B
AD  - Section of Digestive Diseases, Yale University School of Medicine, New Haven, 
      Connecticut, USA; Investigative Medicine Program, Yale Center of Clinical 
      Investigation, New Haven, Connecticut, USA.
FAU - McCarty, Thomas R
AU  - McCarty TR
AD  - Department of Internal Medicine, Yale University School of Medicine, New Haven, 
      Connecticut, USA.
FAU - Varadarajulu, Shyam
AU  - Varadarajulu S
AD  - Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
FAU - Navaneethan, Udayakumar
AU  - Navaneethan U
AD  - Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
LA  - eng
PT  - Journal Article
DEP - 20160830
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Aneuploidy
MH  - Bile Duct Neoplasms/*diagnosis/etiology/genetics/pathology
MH  - Biopsy
MH  - Cholangiocarcinoma/*diagnosis/etiology/genetics/pathology
MH  - Cholangiopancreatography, Endoscopic Retrograde/*economics
MH  - Cholangitis, Sclerosing/*complications
MH  - Constriction, Pathologic
MH  - Cost-Benefit Analysis
MH  - Cytodiagnosis
MH  - Humans
MH  - In Situ Hybridization, Fluorescence
MH  - Monte Carlo Method
MH  - *Quality-Adjusted Life Years
MH  - Trisomy
EDAT- 2016/10/30 06:00
MHDA- 2017/10/12 06:00
CRDT- 2016/09/04 06:00
PHST- 2016/05/07 00:00 [received]
PHST- 2016/08/17 00:00 [accepted]
PHST- 2016/10/30 06:00 [pubmed]
PHST- 2017/10/12 06:00 [medline]
PHST- 2016/09/04 06:00 [entrez]
AID - S0016-5107(16)30526-0 [pii]
AID - 10.1016/j.gie.2016.08.020 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2017 Apr;85(4):773-781.e10. doi: 10.1016/j.gie.2016.08.020. 
      Epub 2016 Aug 30.