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Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures.

Publication ,  Journal Article
Lee, KE; Lim, F; Faye, AS; Shen, B; Hur, C
Published in: Digestive diseases and sciences
December 2022

Endoscopic balloon dilation (EBD) has emerged as an alternative intervention to manage Crohn's disease (CD) strictures. We determined the cost-effectiveness of EBD versus resection surgery for patients with short (< 4-5 cm) primary or secondary/anastomotic small or large bowel strictures.A microsimulation state-transition model analyzed the benefits and risks of EBD and resection surgery for patients with primary or anastomotic CD strictures. Our primary outcome was quality-adjusted life years (QALYs) over ten years, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (2021 $US) and incremental cost-effectiveness ratios (ICER) were calculated. Deterministic 1-way and probabilistic analyses assessed model uncertainty.The EBD strategy cost $19,822 and resulted in 6.18 QALYs while the surgery strategy cost $41,358 and resulted in 6.37 QALYs. Surgery had an ICER of $113,332 per QALY, making EBD a cost-effective strategy. The median number of EBDs was 5 in the EBD strategy and 0 in the surgery strategy. The median number of surgeries was 2 in the surgery strategy and 1 in the EBD strategy. Of individuals who initially received EBD, 50.4% underwent subsequent surgery. One-way sensitivity analyses showed that the probabilities of requiring repeated interventions, surgery mortality (< 0.7%), and quality of life after interventions were the most influential model parameters. Probabilistic sensitivity analyses favored EBD in 50.9% of iterations.EBD is a cost-effective strategy for managing CD strictures. Differences in patient risk and quality of life after intervention impact cost-effectiveness. Intervention decisions should consider cost-effectiveness, patient risks, and quality of life.

Duke Scholars

Published In

Digestive diseases and sciences

DOI

EISSN

1573-2568

ISSN

0163-2116

Publication Date

December 2022

Volume

67

Issue

12

Start / End Page

5462 / 5471

Related Subject Headings

  • Treatment Outcome
  • Quality of Life
  • Humans
  • Gastroenterology & Hepatology
  • Endoscopy, Gastrointestinal
  • Dilatation
  • Crohn Disease
  • Cost-Benefit Analysis
  • Constriction, Pathologic
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lee, K. E., Lim, F., Faye, A. S., Shen, B., & Hur, C. (2022). Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures. Digestive Diseases and Sciences, 67(12), 5462–5471. https://doi.org/10.1007/s10620-022-07420-z
Lee, Kate E., Francesca Lim, Adam S. Faye, Bo Shen, and Chin Hur. “Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures.Digestive Diseases and Sciences 67, no. 12 (December 2022): 5462–71. https://doi.org/10.1007/s10620-022-07420-z.
Lee KE, Lim F, Faye AS, Shen B, Hur C. Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures. Digestive diseases and sciences. 2022 Dec;67(12):5462–71.
Lee, Kate E., et al. “Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures.Digestive Diseases and Sciences, vol. 67, no. 12, Dec. 2022, pp. 5462–71. Epmc, doi:10.1007/s10620-022-07420-z.
Lee KE, Lim F, Faye AS, Shen B, Hur C. Endoscopic Balloon Dilation Is Cost-Effective for Crohn's Disease Strictures. Digestive diseases and sciences. 2022 Dec;67(12):5462–5471.
Journal cover image

Published In

Digestive diseases and sciences

DOI

EISSN

1573-2568

ISSN

0163-2116

Publication Date

December 2022

Volume

67

Issue

12

Start / End Page

5462 / 5471

Related Subject Headings

  • Treatment Outcome
  • Quality of Life
  • Humans
  • Gastroenterology & Hepatology
  • Endoscopy, Gastrointestinal
  • Dilatation
  • Crohn Disease
  • Cost-Benefit Analysis
  • Constriction, Pathologic
  • 3202 Clinical sciences