寒冷或热内镜粘膜切除对于≥15毫米大非支柱状结肠直肠息肉:一个成本效益分析
Sneh Sonaiya1, Dushyant S Dahiya2, Raj Patel3
1Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, NV.
Journal of clinical gastroenterology
|December 15, 2025
概括
冷内镜粘膜切除 (C-EMR) 比热内镜粘膜切除 (H-EMR) 更具成本效益,用于大结直肠多体 (≥15毫米). 与较少的不良事件相比,C-EMR提供了可比的有效性,使其成为首选的策略.
科学领域:
- 胃肠病学 胃肠病学
- 卫生经济学 卫生经济学
- 医疗技术评估 医疗技术评估
背景情况:
- 内镜粘膜切除 (EMR) 是大型非形结直肠多瘤 (LNPCPs ≥15毫米) 的标准.
- 热EMR (H-EMR) 的复发率较低,但延迟多角切除术后出血 (DPPB) 风险较高.
- 寒冷EMR (C-EMR) 的安全性更好,但复发率更高.
研究的目的:
- 进行成本效益分析,比较LNPCP的C-EMR和H-EMR.
- 评估LNPCP管理中的安全性和复发率之间的权衡.
主要方法:
- 使用决策树模型进行增量成本效益分析.
- 从随机对照试验中汇集数据,比较C-EMR和H-EMR.
- 成本包括EMR,延迟出血和住院治疗,来源于CMS数据.
主要成果:
- 分析包括1516个LNPCP (766个C-EMR,750个H-EMR).
- 在基本情况中,C-EMR与每QALY的增量成本为-286.67美元和ICER为-669.448美元有关.
- 与H-EMR相比,C-EMR被发现具有成本效益,在每QALY的支付意愿门为10万美元.
结论:
- 与H-EMR相比,C-EMR是对LNPCP≥15 mm的成本有效策略.
- 较低的H-EMR复发率被较高的不良事件成本 (DPPB,穿孔) 抵消.
- C-EMR为LNPCP管理提供了安全性,有效性和成本的有利平衡.
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