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

Area of Science:

• Gastroenterology
• Health Economics
• Medical Technology Assessment

Background:

• Cold snare polypectomy (CSP) for small colorectal polyps has a higher immediate postpolypectomy bleeding (IPPB) risk than hot snare polypectomy (HSP).
• CSP is associated with a significantly lower risk of delayed postpolypectomy bleeding (DPPB) compared to HSP.
• The trade-offs between IPPB and DPPB necessitate a cost-effectiveness evaluation for small, pedunculated polyps.

Purpose of the Study:

• To evaluate the cost-effectiveness of CSP versus HSP for small (4-10 mm), pedunculated colorectal polyps.
• To compare the economic profiles of two polypectomy techniques considering bleeding risks.

Main Methods:

• A decision tree model was used for cost-effectiveness analysis over a 2-week time horizon.
• Data were sourced from the Multicenter Randomized Taiwan Cold Polypectomy Study and published literature.
• Incremental cost-effectiveness ratio (ICER) was calculated for CSP versus HSP using TreeAge Pro Healthcare 2024.

Main Results:

• In the base case, CSP yielded an ICER of $35,684 per quality-adjusted life year (QALY) compared to HSP.
• CSP remained cost-effective under sensitivity analyses, with specific thresholds for IPPB risk (<21.64%) and DPPB risk (>0.76% with HSP).
• DPPB was evaluated at the patient level (386 participants), and IPPB at the polyp level (647 polyps).

Conclusions:

• CSP is a cost-effective strategy compared to HSP for small pedunculated colorectal polyps at a willingness-to-pay threshold of $100,000/QALY.
• The favorable economic profile of CSP is driven by its lower risk of delayed postpolypectomy bleeding.
• CSP is supported as the preferred technique, though clinical factors remain crucial for individualized patient care.