Cold snare polypectomy versus hot snare polypectomy for small pedunculated polyps: a cost-effectiveness analysis

For small colorectal polyps, cold snare polypectomy (CSP) carries a higher risk of immediate postpolypectomy bleeding (IPPB) compared with hot snare polypectomy (HSP), but is associated with a significantly lower risk of delayed postpolypectomy bleeding (DPPB). Given these trade-offs, we evaluated the cost-effectiveness of CSP versus HSP for small (4-10 mm), pedunculated colorectal polyps.

Cost-effectiveness analysis was conducted over a 2-week time horizon using a decision tree model, based on the Multicenter Randomized Taiwan Cold Polypectomy Study and published literature. Incremental cost-effectiveness ratio (ICER) was calculated for a base case patient undergoing CSP versus HSP, with analysis performed using TreeAge Pro Healthcare 2024.

IPPB was defined as perioperative bleeding requiring clipping, whereas DPPB referred to bleeding within 2 weeks requiring transfusion or endoscopic intervention. DPPB was evaluated at the patient level (386 participants: 192 CSP, 194 HSP), and IPPB at the polyp level (647 polyps: 306 CSP, 341 HSP). In the base case (61.8-year-old with a ≤10 mm pedunculated polyp), CSP versus HSP yielded an ICER of $35,684/quality-adjusted life year (QALY). Sensitivity analyses showed CSP remained cost-effective when IPPB risk after CSP was <21.64% or DPPB risk with HSP exceeded 0.76%.

CSP is cost-effective compared with HSP for small pedunculated polyps at a willingness-to-pay threshold of $100,000/QALY. Despite a higher IPPB risk, CSP's lower DPPB risk underlies its favorable economic profile. Our findings support CSP as the preferred technique for small pedunculated polyps, while emphasizing that patient- and polyp-specific clinical factors should be considered alongside cost-effectiveness in practice.