Document Detail


A cost-efficacy decision analysis of prophylactic clip placement after endoscopic removal of large polyps.
MedLine Citation:
PMID:  23376322     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Delayed bleeding after lower endoscopy and polypectomy can cause significant morbidity. One strategy to reduce bleeding is to place an endoscopic clip on the polypectomy site. We used decision analysis to investigate the cost-effectiveness of routine clip placement after colon polypectomy.
METHODS: Probabilities and plausible ranges were obtained from the literature, and a decision analysis was conducted by using TreeAge Pro 2011 Software. Our cost-effectiveness threshold was an incremental cost-effectiveness ratio of $100,000 per quality-adjusted life year. The reference case was a 50-year-old patient who had a single 1.0- to 1.5-cm polyp removed during colonoscopy. We estimated postpolypectomy bleeding rates for patients receiving no medications, those with planned resumption of antiplatelet therapy (nonaspirin), or those receiving anticoagulation therapy after polypectomy. We performed several sensitivity analyses, varying the cost of a clip and hospitalization, number of clips placed, clip effectiveness in reducing postpolypectomy bleeding, reduction in patient utility days related to gastrointestinal bleeding, and probability of harm from clip placement.
RESULTS: On the basis of the reference case, when patients did not receive anticoagulation therapy, clip placement was not cost-effective. However, for patients who did receive anticoagulation and antiplatelet therapies, prophylactic clip placement was a cost-effective strategy. The cost-effectiveness of a prophylactic clip strategy was sensitive to the costs of clips and hospitalization, number of clips placed, and clip effectiveness.
CONCLUSIONS: Placement of a prophylactic endoscopic clip after polypectomy appears to be a cost-effective strategy for patients who receive antiplatelet or anticoagulation therapy. This approach should be studied in a controlled trial.
Authors:
Neehar D Parikh; Kyle Zanocco; Rajesh N Keswani; Andrew J Gawron
Publication Detail:
Type:  Comment; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2013-01-30
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  11     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-23     Completed Date:  2014-04-23     Revised Date:  2014-10-12    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1319-24     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Colonoscopy / adverse effects*
Endoscopy / adverse effects*
Female
Gastrointestinal Hemorrhage / epidemiology*
Humans
Intestinal Polyps / surgery*
Male
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Complications / epidemiology*
Pyridines / therapeutic use*
Grant Support
ID/Acronym/Agency:
5T32DK077662-04/DK/NIDDK NIH HHS; T-32 HS 000078/HS/AHRQ HHS; T32 DK077662/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Pyridines; 0/thienopyridine
Comments/Corrections
Comment On:
Clin Gastroenterol Hepatol. 2013 Oct;11(10):1325-32   [PMID:  23403011 ]
Comment In:
Clin Gastroenterol Hepatol. 2013 Oct;11(10):1333-4   [PMID:  23756223 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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