Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis
- 7 October 2017
- Vol. 67 (11), 1965-1973
- https://doi.org/10.1136/gutjnl-2017-313823
Abstract
Objective To compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm. Design An incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed. Results 1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions. Conclusion S-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs. Trial registration number NCT02000141.Keywords
Funding Information
- National Health and Medical Research Council
This publication has 56 references indexed in Scilit:
- Current status of endoscopic resection strategy for large, early colorectal neoplasia in JapanSurgical Endoscopy, 2013
- Endoscopic submucosal dissection for colorectal tumors—1,000 colorectal ESD cases: one specialized institute’s experiencesSurgical Endoscopy, 2012
- Current Status of Colorectal Endoscopic Submucosal Dissection in KoreaClinical Endoscopy, 2012
- The Cooperative Italian FLIN Study Group: prevalence and clinico-pathological features of colorectal laterally spreading tumorsEndoscopy, 2011
- High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical InterventionsAnnals of Internal Medicine, 2011
- Endoscopic submucosal dissection for laterally spreading tumours of the colorectum in 200 consecutive casesSurgical Endoscopy, 2010
- Complications in colorectal surgery: risk factors and preventive strategiesPatient Safety in Surgery, 2010
- Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancerGastrointestinal Endoscopy, 2006
- Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectumGut, 2006
- The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002Gastrointestinal Endoscopy, 2003