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Endoscopy 2022; 54(04): 367-375
DOI: 10.1055/a-1469-2644
Original article

Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis

Dhairya Mehta
1   Department of Medicine, University Hospitals, Cleveland, Ohio, USA
2   Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
3   Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
,
Adam H. Loutfy
1   Department of Medicine, University Hospitals, Cleveland, Ohio, USA
,
Vladimir M. Kushnir
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
,
Ashley L. Faulx
1   Department of Medicine, University Hospitals, Cleveland, Ohio, USA
2   Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
,
Zachary L. Smith 
1   Department of Medicine, University Hospitals, Cleveland, Ohio, USA
2   Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
5   Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Author commentary on Dhairya Mehta et al.Endoscopy 2022; 54(04): v13-v13
DOI: 10.1055/a-1506-2381

Abstract

Background For large sessile colorectal polyps (LSCPs), endoscopic mucosal resection without diathermy (“cold endoscopic mucosal resection [EMR]”) is gaining popularity because of its safety advantages over conventional EMR (“hot EMR”). Polyp recurrence rates have been reported to be higher with cold EMR. Considering these differences, we performed a cost-effectiveness analysis of these two techniques.

Methods A decision analysis model was constructed for EMR of an LSCP. The decision tree incorporated the EMR method, clip use, procedural mortality, adverse events and their management, and polyp recurrence. Outcomes included days of lost productivity and marginal cost difference. Adverse event and recurrence rates were extracted from the existing literature, giving emphasis to recent systematic reviews and randomized controlled trials.

Results Through 30 months of follow-up, the average cost of removing an LSCP by cold EMR was US$5213, as compared to $6168 by hot EMR, yielding a $955 cost difference (95 % confidence interval $903–$1006). Average days of lost productivity were 6.2 days for cold EMR and 6.3 days for hot EMR. This cost advantage remained over several analyses accounting for variations in recurrence rates and clip closure strategies. Clip cost and LSCP recurrence rate had the greatest and the least impacts on the marginal cost difference, respectively.

Conclusion Cold EMR is the dominant strategy over hot EMR, with lower cost and fewer days of lost productivity. In theory, a complete transition to cold EMR for LSCPs in the USA could result in an annual cost saving approaching US$7 million to Medicare beneficiaries.

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Publication History

Received: 07 July 2020

Accepted: 29 March 2021

Accepted Manuscript online:
29 March 2021

Article published online:
26 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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