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Endoscopic resection cost-effective for benign rectal polyps
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Endoscopic resection with careful follow-up was similarly effective to and more cost-effective than other techniques for the management of benign rectal polyps, according to study results.
Jessica X. Yu, MD, MS, of the division of gastroenterology and hepatology at Stanford University, and colleagues wrote that although studies have shown that endoscopic resection (ER) is safe and effective, little is known about the long-term outcomes of rectal polyps management or the cost-effectiveness of ER compared with two other surgical methods, transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS).
“Moreover, few studies have assessed the role of loss to follow-up,” they wrote. “Although ER may have lower short-term costs, long-term outcomes may be worse for ER patients who are lost to follow-up because of increased risk of rectal cancer.”
Researchers created a Markov model to simulate the lifetime outcomes and costs of the three techniques for the management of benign rectal polyps over the course of a 50-year time horizon. They also assessed the effect of surveillance by allowing some of the patients to be lost to follow-up.
Although TEM was slightly more effective in terms of quality-adjusted life years (QALY) than TAMIS or ER (TEM, 19.54 QALYs; TAMIS, 19.53 QALYs; and ER, 19.53 QALYs), ER had the lowest lifetime discounted cost (ER cost $7,161; TEM cost $10,459; and TAMIS cost $11,253).
Investigators found that ER was more cost-effective at a $100,000/QALY willingness-to-pay threshold, while TER had an incremental cost-effectiveness ratio of $485,333/QALY.
However, if mortality exceeded 0.63% or loss to follow-up exceeded 25.5% in ER, TEM became cost-effective.
“Our findings are sensitive to procedural mortality rate, and loss to follow-up rate,” Yu and colleagues concluded. “Future efforts should focus on understanding the long-term outcomes of each procedure and the differential risks of rectal cancer development after resection.” – by Alex Young
Disclosures: Yu reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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