Cost-Effectiveness of Early Versus Late Interventional Radiology Drainage in Necrotizing Pancreatitis: A Decision...

The optimal timing of interventional radiology (IR) drainage in patients with necrotizing pancreatitis remains uncertain. This study compares the cost-effectiveness of early (five to six weeks) vs. late (> six weeks) IR drainage using a decision analysis model.

A retrospective cohort of 76 patients with severe necrotizing pancreatitis (2017-2021) was screened. Twenty-two patients met the inclusion criteria and were included in a decision analysis model; 11 underwent early IR drainage and 11 underwent late IR drainage. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A budget impact analysis was also conducted.

Early IR drainage was associated with shorter ICU stays (mean 17 vs. 26 days, p=0.01) and fewer IR drainage sessions (median 12 vs. 28, p=0.04) compared to late drainage. Readmissions were fewer in the early group (four vs. eight; p=0.31), although this difference was not statistically significant. Rates of surgery, including ischemia or fistula, disconnected pancreatic duct syndrome, and bleeding complications, were comparable between groups. Total costs were lower in the early drainage group (£23,533-£48,526) vs. the late group (£29,168-£56,110), with slightly higher QALYs (1.77 vs. 1.76 years). The ICER for early drainage was £15,340.96 per QALY gained, within accepted UK willingness-to-pay thresholds. The budget impact analysis projected annual healthcare savings of £75,835 with early intervention.

In this small decision analysis, IR drainage at five to six weeks demonstrated cost-effectiveness advantages, with significantly shorter ICU stays, fewer drainage procedures, reduced costs, and similar complication rates compared to drainage after six weeks. Larger prospective studies are needed to validate these findings and guide clinical practice.