Cost‐effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection

Abstract

Objectives:The cost-effectiveness of endoscopic submucosal dissection (ESD) and piecemeal endoscopic mucosal resection (pEMR) for colorectal laterally spreading tumors (LSTs) remains unclear. We examined the cost-effectiveness of these procedures for cases of colon/rectal LST-non-granular-type ≥2 cm and LST-granular-mixed-type ≥3 cm. Methods:We performed a simulation model analysis using parameters based on clinical data from the National Cancer Center Hospital, Tokyo, and previous literature. The number of recurrences and surgeries and the required costs for 5 years following ESD and pEMR were assessed. Japanese cost data were used in the base-case analysis, and probabilistic sensitivity analysis (PSA) was performed. The Swedish cost data were used in the scenario analysis.Results: Endoscopic submucosal dissection yielded a considerably lower number of recurrences and surgeries but required a higher cost than pEMR. The recurrence rates following ESD and pEMR were 0.9-1.3% and 21.1-25.9%, respectively. The incremental cost-effectiveness ratios for an avoided recurrence and surgery for ESD against pEMR were 376, 335,187,476 JPY (69,689 USD), respectively. PSA demonstrated that the probability of ESD being chosen as a more cost-effective option than pEMR was >50% at willingness-to-pay values of ≥400,000-500,000 JPY (3795-4744 USD) for avoiding a recurrence and ≥9,500,000-10,500,000 JPY (90,143-99,631 USD) for avoiding a surgery. In the scenario analysis, the required cost was also lower for ESD.Conclusions: Our findings suggest potentially favorable costeffectiveness of ESD, depending on cost settings and the willingness-to-pay value for avoiding recurrence/surgery.

Evaluation of the extended Japan NBI expert team classification of subtype 2B in laterally spreading colorectal tumors based on blue laser imaging

“…LSTs of less than 20 mm in diameter can be treated with EMR, 24 while ESD is recommended for those with a diameter exceeding 20 mm or larger as it has a higher overall resection rate and lower local recurrence rate. 25,26 Our study found that there was no significant difference in the pathological features of JNET2B-low and JNET2B-high LSTs when using a cut-off value of 20 mm for lesion size. Therefore, the classification of LSTs into JNET2B-low and JNET2B-high is also suitable for tumors of different sizes.…”

Cost‐effectiveness analysis of single colonoscopy versus single fecal test for colorectal cancer diagnosis and treatment

“…The treatment procedure was determined by each lesion characteristic as follows: First, all adenomas: endoscopic resection including hot snare polypectomy, cold snare polypectomy, and endoscopic mucosal resection, Stage 0 cancer <20 mm: hot snare polypectomy or endoscopic mucosal resection, Stage 0 cancer ≥20 mm: endoscopic submucosal dissection (ESD), Stage 1 cancer <1000 μm of submucosa: ESD, Stage 1 cancer >1000 μm or Stage 2 cancer: surgery, Stage 3 cancer: surgery ± chemotherapy, Stage 4 cancer: chemotherapy. The initial cost for the treatment of stage 0–4 cancer was defined in previous reports that investigated the treatment cost for CRC under the Japanese healthcare insurance system 12,13 …”

“…The initial cost for the treatment of stage 0-4 cancer was defined in previous reports that investigated the treatment cost for CRC under the Japanese healthcare insurance system. 12,13 Second, the number of patient examinations needed for the analysis was based on a previous report. 14 In this analysis, the number of examinations required to treat one adenoma, advanced adenoma, or cancer was calculated for the two strategies.…”