Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis

BackgroundControlled trials support pancreatic-stent placement as an effective intervention for the prevention of post-ERCP acute pancreatitis in high-risk patients.ObjectiveTo perform a decision analysis to evaluate the most cost-effective strategy for preventing post-ERCP pancreatitis.DesignCost-effectiveness analysis.SettingPatients undergoing ERCP.InterventionsThree competing strategies were evaluated in a decision analysis model from a third-party–payer perspective in hypothetical patients undergoing ERCP. In strategy I, none of the patients had pancreatic-stent placement. Strategy II had only those patients identified to be at high risk for post-ERCP, and, in strategy III, all patients underwent prophylactic stent placement. Probabilities of developing post-ERCP pancreatitis and the risk reduction by placement of a pancreatic stent were obtained from published information. Cost estimates were obtained from Medicare reimbursement rates.Main Outcome MeasurementsIncremental cost-effectiveness ratio (ICER) of different strategies.ResultsStrategy I was the least-expensive strategy but yielded the least number of life years. Strategy II yielded the highest number of years of life, with an ICER of $11,766 per year of life saved, and strategy III was dominated by strategy II.LimitationsIndirect costs and pharmacologic prophylaxis were not considered in this analysis.ConclusionsPancreatic-stent placement for the prevention of post-ERCP pancreatitis in high-risk patients is a cost-effective strategy.