Document Detail


A Cost Efficacy Decision Analysis of Prophylactic Clip Placement After Endoscopic Removal of Large polyps.
MedLine Citation:
PMID:  23376322     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND 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 using TreeAge Pro 2011 (TreeAge Software, Williamstown, MA). 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 1.0-1.5 cm polyp removed during colonoscopy. We estimated post-polypectomy bleeding rates for patients receiving no medications, those with planned resumption of anti-platelet 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 post-polypectomy bleeding, reduction in patient utility days related to gastrointestinal bleeding, and probability of harm from clip placement. RESULTS: Based on the reference case, when patients did not receive anti-coagulation therapy, clip placement was not cost effective. However for patients who did receive anticoagulation and anti-platelet 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 anti-platelet or anticoagulation therapy. This approach should be studied in a controlled trial.
Authors:
Neehar Parikh; Kyle Zanocco; Rajesh N Keswani; Andrew J Gawron
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-30
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago IL; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago IL. Electronic address: n-parikh@fsm.northwestern.edu.
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