BACKGROUND AND AIMS: Endoscopic resection (ER) is an efficacious treatment for complex @entity1586 (CCPs). Many @entity1 are referred for surgical resection because of concerns over procedural safety, incomplete polyp resection, and @entity652 recurrence after ER. Efficacy data for both resection strategies are widely available, but a paucity of data exist on the cost-effectiveness of each modality. The aim of this study was to perform an economic analysis comparing ER and laparoscopic resection (LR) strategies in @entity1 with CCP. METHODS: A decision analysis tree was constructed using decision analysis software. The 2 strategies (ER vs LR) were evaluated in a hypothetical cohort of @entity1 with CCPs. A hybrid Markov model with a 10-year time horizon was used. @entity1 entered the model after colonoscopic diagnosis at age 50. Under Strategy I, @entity1 underwent ER followed by surveillance colonoscopy at 3 to 6 months and 12 months. @entity1 with failed ER and residual @entity652 at 12 months were referred for LR. Under Strategy II, @entity1 underwent LR as primary treatment. @entity1 with @entity3 were excluded. Estimates regarding ER performance characteristics were obtained from a systematic review of published literature. The Centers for Medicare _ Medicaid Services (2012-2013) and the 2012 Healthcare Cost and Utilization Project databases were used to determine the costs and loss of utility. We assumed that all procedures were performed with anesthesia support, and @entity1 with adverse events in both strategies required inpatient hospitalization. Baseline estimates and costs were varied by using a sensitivity analysis through the ranges. RESULTS: LR was found to be more costly and yielded fewer quality-adjusted life-years (QALYs) compared with ER. The cost of ER of a CCP was  5570 per @entity1 and yielded 9.640 QALYs. LR of a CCP cost  18,717 per @entity1 and yielded fewer QALYs (9.577). For LR to be more cost-effective, the thresholds of 1-way sensitivity analyses were (1) technical success of ER for complete resection in  <75.8% of cases, (2) adverse event rates for ER > 12%, and (3) LR cost of  < 14,000. CONCLUSIONS: Our data suggest that ER is a cost-effective strategy for removal of CCPs. The effectiveness is driven by high technical success and low adverse event rates associated with ER, in addition to the increased cost of LR.

Endoscopic resection is cost-effective compared with laparoscopic  resection in the management of complex XXXX : an economic analysis.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity652 :: ('MESH:D000236', 'Disease') :: ['adenoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['invasive cancer'] @entity1586 :: ('MESH:D003111', 'Disease') :: ['colon polyps']
@entity1586 :: (MESH:D003111,Disease) :: ['colon  polyps']
