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Background <p>Endoscopic ultrasound (EUS)-guided biliary drainage is a promising alternative for malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the cost-effectiveness of EUS-guided gallbladder drainage (EUS-GB) and EUS-guided choledochoduodenostomy (EUS-CBD) compared to percutaneous transhepatic biliary drainage (PTBD) in these patients.</p> Methods <p>A decision analysis model compared costs and quality-adjusted life years (QALYs) over two years for patients with MDBO after failed ERCP, undergoing EUS-GB, EUS-CBD, or PTBD. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were calculated at a willingness-to-pay threshold of $100,000 per QALY. Probabilistic and deterministic sensitivity analyses were performed.</p> Results <p>Both EUS-GB and EUS-CBD were more cost-effective than PTBD. PTBD cost $14,988, EUS-GB cost $14,520 (adding 0.38 QALYs and $37,768 incremental NMB), and EUS-CBD cost $17,694 (adding 0.55 QALYs and $52,171 incremental NMB). Although PTBD had the lowest cost, it was dominated due to fewer QALYs. Results were robust in sensitivity analyses.</p> Conclusion <p>EUS-GB and EUS-CBD are more cost-effective than PTBD for MDBO after failed ERCP. EUS-GB offers similar value to EUS-CBD, potentially with lower reintervention rates. Endoscopic management should be prioritized over PTBD for these patients.</p>

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Endoscopic ultrasound-guided biliary drainage is cost-effective for treatment of malignant distal biliary obstruction after failed ERCP

  • 期刊论文

  • 发表日期：

    2025年10月23日

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  • Noppachai Siranart,
  • Patavee Pajareya,
  • Steven N. Steinway

摘要

Background

Endoscopic ultrasound (EUS)-guided biliary drainage is a promising alternative for malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the cost-effectiveness of EUS-guided gallbladder drainage (EUS-GB) and EUS-guided choledochoduodenostomy (EUS-CBD) compared to percutaneous transhepatic biliary drainage (PTBD) in these patients.

Methods

A decision analysis model compared costs and quality-adjusted life years (QALYs) over two years for patients with MDBO after failed ERCP, undergoing EUS-GB, EUS-CBD, or PTBD. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were calculated at a willingness-to-pay threshold of $100,000 per QALY. Probabilistic and deterministic sensitivity analyses were performed.

Results

Both EUS-GB and EUS-CBD were more cost-effective than PTBD. PTBD cost $14,988, EUS-GB cost $14,520 (adding 0.38 QALYs and $37,768 incremental NMB), and EUS-CBD cost $17,694 (adding 0.55 QALYs and $52,171 incremental NMB). Although PTBD had the lowest cost, it was dominated due to fewer QALYs. Results were robust in sensitivity analyses.

Conclusion

EUS-GB and EUS-CBD are more cost-effective than PTBD for MDBO after failed ERCP. EUS-GB offers similar value to EUS-CBD, potentially with lower reintervention rates. Endoscopic management should be prioritized over PTBD for these patients.