PMID- 38061478 OWN - NLM STAT- Publisher LR - 20231207 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) DP - 2023 Dec 5 TI - Assessing the impact of center volume on the cost-effectiveness of centralizing ERCP. LID - S0016-5107(23)03135-8 [pii] LID - 10.1016/j.gie.2023.11.058 [doi] AB - BACKGROUND AND AIMS: ERCP is a complex endoscopic procedure in which the center's procedure volume influences outcomes. With the increasing healthcare expenses and limited resources, promoting cost-effective care becomes essential for healthcare provision. This study performed a cost-effectiveness analysis to evaluate the hypothesis that high-volume (HV) centers perform ERCP with higher quality at lower costs than low-volume (LV) centers. METHODS: A baseline case compared the current distribution of ERCPs among HV and LV centers with a hypothetical scenario in which all ERCPs are performed at HV centers. A cost-effectiveness analysis was constructed, followed by one-way and two-way sensitivity analyses and probabilistic sensitivity analysis (PSA) using Monte Carlo simulations. RESULTS: In the baseline case, the ICER was -141,017euro/year, due to the hypothetical scenario's lower costs and slightly higher QALYs. The model was most sensitive to changes in the transportation costs (109.34%), probability of significant adverse events (AEs) after successful ERCP at LV centers (42.12%), utility after ERCP with significant AEs (30.10%), and probability of significant AEs after successful ERCP at HV centers (23.53%) but only transportation cost above 3,407euro changed the study outcome. The current ERCP distribution would only be cost-effective if LV centers achieved higher success (>/= 92.4% vs. 89.3%) with much lower significant AEs (