Document Detail


Does rectal indomethacin eliminate the need for prophylactic pancreatic stent placement in patients undergoing high-risk ERCP? Post hoc efficacy and cost-benefit analyses using prospective clinical trial data.
MedLine Citation:
PMID:  23295278     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: A recent large-scale randomized controlled trial (RCT) demonstrated that rectal indomethacin administration is effective in addition to pancreatic stent placement (PSP) for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk cases. We performed a post hoc analysis of this RCT to explore whether rectal indomethacin can replace PSP in the prevention of PEP and to estimate the potential cost savings of such an approach.
METHODS: We retrospectively classified RCT subjects into four prevention groups: (1) no prophylaxis, (2) PSP alone, (3) rectal indomethacin alone, and (4) the combination of PSP and indomethacin. Multivariable logistic regression was used to adjust for imbalances in the prevalence of risk factors for PEP between the groups. Based on these adjusted PEP rates, we conducted an economic analysis comparing the costs associated with PEP prevention strategies employing rectal indomethacin alone, PSP alone, or the combination of both.
RESULTS: After adjusting for risk using two different logistic regression models, rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP. Economic analysis revealed that indomethacin alone was a cost-saving strategy in 96% of Monte Carlo trials. A prevention strategy employing rectal indomethacin alone could save approximately $150 million annually in the United States compared with a strategy of PSP alone, and $85 million compared with a strategy of indomethacin and PSP.
CONCLUSIONS: This hypothesis-generating study suggests that prophylactic rectal indomethacin could replace PSP in patients undergoing high-risk ERCP, potentially improving clinical outcomes and reducing healthcare costs. A RCT comparing rectal indomethacin alone vs. indomethacin plus PSP is needed.
Authors:
B Joseph Elmunzer; Peter D R Higgins; Sameer D Saini; James M Scheiman; Robert A Parker; Amitabh Chak; Joseph Romagnuolo; Patrick Mosler; Rodney A Hayward; Grace H Elta; Sheryl J Korsnes; Suzette E Schmidt; Stuart Sherman; Glen A Lehman; Evan L Fogel;
Related Documents :
8693978 - Outcome analysis of preoperative embolization with n-butyl cyanoacrylate in cerebral ar...
897988 - Intracranial arteriovenous malformations: conservative or surgical treatment?
24287258 - The effect of ozone on progression or regression of artificial caries-like enamel lesio...
12234398 - Role of venous drainage in cerebral arteriovenous malformation surgery, as related to t...
8693978 - Outcome analysis of preoperative embolization with n-butyl cyanoacrylate in cerebral ar...
16360968 - The utility of microvascular perfusion assessment in heart failure: a pilot study.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-08
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  108     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-05-20     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  410-5     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Administration, Rectal
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*,  economics
Cost-Benefit Analysis
Female
Humans
Indomethacin / administration & dosage,  economics,  therapeutic use*
Male
Middle Aged
Pancreatitis / economics,  etiology,  prevention & control*
Prospective Studies
Retrospective Studies
Risk Factors
Stents / economics*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1R21DK090343/DK/NIDDK NIH HHS; KL2 RR024987/RR/NCRR NIH HHS; R21 DK090343/DK/NIDDK NIH HHS; UL1 RR024986/RR/NCRR NIH HHS; UL1RR024986/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
XXE1CET956/Indomethacin
Comments/Corrections

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


Previous Document:  Rate of early/missed colorectal cancers after colonoscopy in older patients with or without inflamma...
Next Document:  A Random Urine Test Can Identify Patients at Risk of Mesalamine Non-Adherence: A Prospective Study.