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Bahin FF, Heitman SJ, Bourke MJ. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut 2019; 68:1130. [PMID: 29778995 DOI: 10.1136/gutjnl-2018-316660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Farzan F Bahin
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Steven J Heitman
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Dahan M, Pauliat E, Liva-Yonnet S, Brischoux S, Legros R, Tailleur A, Carrier P, Charissoux A, Valgueblasse V, Loustaud-Ratti V, Taibi A, Durand-Fontanier S, Valleix D, Sautereau D, Kerever S, Jacques J. What is the cost of endoscopic submucosal dissection (ESD)? A medico-economic study. United European Gastroenterol J 2018; 7:138-145. [PMID: 30788126 DOI: 10.1177/2050640618810572] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/23/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) is the gold-standard treatment for superficial lesions of the digestive tract. No medico-economic study has been conducted in Europe. Material and methods A monocentric study was conducted including all patients undergoing ESD between January 2015 and December 2017. The global cost of hospital stays was measured by microcosting, and revenue was based on the diagnosis-related group (DRG) system. The primary objective was to assess the cost/revenue balance. A medico-economic comparison with surgery was performed as a secondary outcome. Results A total of 193 patients were prospectively included. The cost per procedure was €3463.79, subtracted from a €2726.84 revenue, with a deficit of -€736.96 per stay. Presence of comorbidities/complications increasing DRG value was the only predictive factor for a positive budgetary balance in a multivariate analysis (odds ratio 49.21, 95% confidence interval 11.3-214.25, p < 0.0001). In comparison with surgery, ESD was associated with shorter length of stay (11 vs 2 days; p < 0.0001) and lower morbidity (28% vs 14%; p = 0.061), lower cost (€8960 vs €1770; p < 0.0001). Conclusion The ESD cost/revenue balance is negative in 80% of cases. Given the benefits of ESD in terms of patient morbidity and financial savings compared with surgery, the implementation of a specific ESD reimbursement is warranted.
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Affiliation(s)
- Martin Dahan
- Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | - Sandra Liva-Yonnet
- Information Médicale et de l'information, CHU Dupuytren, Limoges, France
| | | | - Romain Legros
- Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | - Paul Carrier
- Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | | | | | - Abdelkader Taibi
- Chirurgie digestive et endocrinienne, CHU Dupuytren, Limoges, France
| | | | - Denis Valleix
- Chirurgie digestive et endocrinienne, CHU Dupuytren, Limoges, France
| | | | - Sébastien Kerever
- Biostatistique et information médicale, Hôpital Saint Louis APHP, Paris, France
| | - Jérémie Jacques
- Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.,Xlim, BioEM, UMR 7252, CNRS, Limoges, France
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