Abstract
Background
Gastroenterologists frequently face the dilemma of how to choose among different management options.
Aim
To develop a tool of medical decision analysis that helps choosing between competing management options of interventional endoscopy and surgery.
Methods
Carcinoma-in-situ of the esophagus, large colonic polyps, and ampullary adenoma serve as three examples for disorders being managed by both techniques. A threshold analysis using a decision tree was modeled to compare the costs and utility values associated with managing the three examples. If the expected healing or success rate of interventional endoscopy exceeds a threshold calculated as the ratio of endoscopy costs over surgery costs, endoscopy becomes the preferred management option. A low threshold speaks in favor of endoscopic intervention as initial management strategy.
Results
If the decision in favor of surgery is focused exclusively on preventing death from a given disease, surgical intervention may seem to provide the best treatment option. However, interventional endoscopy becomes a viable alternative, if the comparison is based on a broader perspective that includes adverse events and long-term disability, as well as the healthcare costs of both procedures. For carcinoma-in-situ of the esophagus, the threshold for the expected success rate is 24% (range in the sensitivity analysis: 7–29%); for large colonic polyps it is 10% (5–12%), and for duodenal papillary adenoma it is 17% (5–21%).
Conclusions
Even if a management strategy surpasses its alternative with respect to one important outcome parameter, there is often still room for the lesser alternative to be considered as viable option.
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Conception and design: AS, GB, PB; decision analysis: AS; writing of manuscript: AS, GB, PB.
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Amnon Sonnenberg, Gennadiy Bakis, and Peter Bauerfeind have no conflict of interest or financial ties to disclose.
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Sonnenberg, A., Bauerfeind, P. & Bakis, G. Cost-utility advantage of interventional endoscopy. Surg Endosc 37, 1031–1037 (2023). https://doi.org/10.1007/s00464-022-09599-8
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DOI: https://doi.org/10.1007/s00464-022-09599-8