Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage in Patients With Malignant Biliary Obstruction: Which Is the Optimal Cost-Saving Strategy After Failed ERCP?

Won Jae Yoon; Eric D Shah; Tae Hoon Lee; Sunguk Jang; Ryan Law; Do Hyun Park

doi:10.3389/fonc.2022.844083

Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage in Patients With Malignant Biliary Obstruction: Which Is the Optimal Cost-Saving Strategy After Failed ERCP?

Front Oncol. 2022 Feb 25:12:844083. doi: 10.3389/fonc.2022.844083. eCollection 2022.

Authors

Won Jae Yoon¹, Eric D Shah², Tae Hoon Lee³, Sunguk Jang⁴, Ryan Law⁵, Do Hyun Park⁶

Affiliations

¹ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.
² Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
³ Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea.
⁴ Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States.
⁵ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
⁶ Digestive Diseases Research Center, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

Abstract

Background and aim: Although endoscopic ultrasound-guided biliary drainage (EUS-BD) after failed primary ERCP in malignant distal biliary obstruction has similar clinical outcomes compared to percutaneous transhepatic biliary drainage (PTBD), little is known about optimal cost-saving strategy after failed ERCP. We performed a cost analysis of EUS-BD and PTBD after failed ERCP in two countries with different health care systems in the East and West.

Methods: From an unpublished database nested in a randomized controlled trial, we compared the cost between EUS-BD and PTBD in Korea. The total cost was defined as the sum of the total biliary drainage costs plus the cost of hospital stay to manage adverse events. We also performed a cost-minimization analysis using a decision-analytic model of a US Medicare population.

Results: In Korea, the median total costs for the biliary intervention ($1,203.36 for EUS-BD vs. $1,517.83 for PTBD; P=.0015) and the median total costs for the entire treatment were significantly higher in PTBD ($4,175.53 for EUS-BD vs. $5,391.87 for PTBD; P=.0496) due to higher re-intervention rate in PTBD. In cost-minimization analysis of US Medicare population, EUS-BD would cost $9,497.03 and PTBD $13,878.44 from a Medicare insurance perspective (average cost-savings in choosing EUS-BD of $4,381.41 in the US). In sensitivity analysis, EUS-BD was favored over PTBD regardless of the expected re-intervention rate in EUS-BD and PTBD.

Conclusions: EUS-BD may have an impact on cost-savings due to better clinical outcomes profile compared to PTBD after failed ERCP, even in different medical insurance programs.

Keywords: ERCP; biliary tract obstruction; endoscopic ultrasound; medical cost; percutaneous transhepatic biliary drainage.