November 12, 2014
Notes: Lappalainen-Lehto, Riitta
Randomized Controlled Trial
Addict Behav. 2013 Dec;38(12):2805-9. doi: 10.1016/j.addbeh.2013.07.008. Epub 2013 Jul 21.
Author Address: Tampere University Hospital, Finland. Electronic address: email@example.com.
Reference Type: Journal Article
Record Number: 4931Author: Laramee, P., Wonderling, D., Cahen, D. L., Dijkgraaf, M. G., Gouma, D. J., Bruno, M. J. and Pereira, S. P.
Title: Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis
Journal: BMJ Open
Short Title: Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis
Alternate Journal: BMJ open
ISSN: 2044-6055 (Electronic)
Accession Number: 24065699
Abstract: OBJECTIVE: Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis. DESIGN: This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. SETTING: Hospital. PARTICIPANTS: Patients with obstructive chronic pancreatitis. PRIMARY AND SECONDARY OUTCOME MEASURES: Costs, QALYs and cost-effectiveness. RESULTS: The result of the base-case analysis was that surgical drainage dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the surgical option remained dominant in all scenarios. The probability of cost-effectiveness for surgical drainage was 100% for the base case and 82% in the assessed most conservative case scenario. CONCLUSIONS: In obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared with endoscopic drainage from a UK NHS perspective.