Noninvasive vs. selective invasive biliary imaging for acute biliary pancreatitis: an economic evaluation by using decision tree analysis

摘要: Background ERCP is used selectively in patients with acute biliary pancreatitis (ABP). In ABP, often difficult and has the potential to cause further damage. addition, prevalence of residual choledocholithiasis ABP low ( Methods A decision tree was constructed, modeling standard care for nonsevere (selective ERCP) severe (ERCP sphincterotomy balloon sweep). The other arms included either EUS or MRCP first, conversion addition when a bile-duct stone seen. Probabilities accuracy were taken from published data. Costs locally quantified Canadian dollars (CDN), including nursing/technical/professional personnel, equipment maintenance, disposable equipment. robustness assumptions tested by sensitivity analyses. Results Overall, all marginally dominant compared selective ($58 CDN per patient less expensive; 0.9% fewer cases [ERCP-related recurrent]). subgroup, more clearly ($742 3% pancreatitis), subgroup had an incremental cost-effectiveness ratio $17,000 case avoided. expensive than both subgroups. Conclusions ABP. it slightly costly but associated ERCPs ERCP-related complications. randomized trial would help quantify benefits avoiding these patients.