Introduction Two published randomised controlled trials (RCTs)1 ,2 have reported that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. The objective of this analysis was to assess the cost-effectiveness of surgical vs endoscopic drainage in obstructive chronic pancreatitis.
Methods This analysis was conducted mainly based on one RCT1, from a UK National Health Service perspective, and over a 24-month time horizon for the base-case analysis (median follow-up time in the trial). A lifetime horizon was used in the sensitivity analysis. The health outcome was the Quality-Adjusted Life Year (QALY), which was generated using EQ-5D data collected during the trial. Also collected were details of the use of diagnostic and therapeutic procedures, time in hospital and the treatment of pancreatic exocrine and endocrine insufficiency. This resource use was combined with UK unit costs. Key elements of resource use, such as complication rates and conversion to surgery were varied in sensitivity analyses. The trial reported one death in the endoscopy group (5%), which was not clearly related to the intervention. For the base-case analysis, we assumed no mortality in either group and applied a mortality rate of up to 2% to surgical drainage in the sensitivity analysis.
Results The result of the base-case analysis was that surgical drainage of the pancreatic duct dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis showed that the surgical option remained dominant in a majority of scenarios. When compared with a threshold of £20 000 per QALY gained, all analyses indicated that the probability that surgical drainage is cost-effective compared to endoscopic drainage exceeds 95%.
Conclusion In patients with obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared to endoscopic drainage. This economic analysis was developed from a UK perspective, but given the magnitude of the improvement in quality of life, the substantial cost savings and the robustness of the results to sensitivity analyses, it is likely that this conclusion can be generalised to other healthcare systems.
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