• Annals of surgery · Apr 2023

    Randomized Controlled Trial Multicenter Study

    Cost-Effectiveness of Early Surgery Versus Endoscopy-First Approach for Painful Chronic Pancreatitis in the ESCAPE Trial.

    • Marinus A Kempeneers, Yama Issa, Marco J Bruno, Hjalmar C van Santvoort, Marc G Besselink, Marja A Boermeester, Marcel G Dijkgraaf, and Dutch Pancreatitis Study Group.
    • Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
    • Ann. Surg. 2023 Apr 1; 277 (4): e878e884e878-e884.

    ObjectiveEconomic evaluation of early surgery compared to the endoscopy-first approach in CP.BackgroundIn patients with painful CP and a dilated main pancreatic duct, early surgery, as compared with an endoscopy-first approach, leads to more pain reduction with fewer interventions. However, it is unknown if early surgery is more cost-effective than the endoscopy-first approach.MethodsThe multicenter Dutch ESCAPE trial randomized patients with CP and a dilated main pancreatic duct between early surgery (surgery within 6 weeks) or the endoscopy-first approach in 30 centers (April 2011-September 2016). Healthcare utilization was prospectively recorded up to 18 months after randomization. Unit costs of resources were determined, and cost-effectiveness and cost-utility analyses were performed from societal and healthcare perspectives. Primary outcomes were the costs per unit decrease on the Izbicki pain score and per gained quality-adjusted life-year.ResultsIn total, 88 patients were included in the analysis, with 44 patients randomized to each group. Total costs were lower in the early surgery group but did not reach statistical significance (mean difference €-4,815 (95% bias-corrected and accelerated confidence interval €-13,113 to €3411; P = 0.25). Early surgery had a probability percentage of 88.4% of being more cost-effective than the endoscopy-first approach at a willingness-to-pay threshold of €0 per day per unit decrease on the Izbicki pain score. The probability percentage per additional gained quality-adjusted life-year was 75.7% at a willingness-to-pay threshold of €50,000.ConclusionIn patients with painful CP and a dilated main pancreatic duct, early surgery was more cost-effective than the endoscopy-first approach.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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