A CLINICAL DECISION ANALYSIS TO ASSESS THE VALUE OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR THE TREATMENT OF EARLY GASTRIC CANCER WITH RESPECT TO CLINICAL OUTCOMES AND COST-EFFECTIVENESS

HABU Yasuki, HAYAKUMO Takanobu, YAMAZAKI Maki, SHIO Seiji, YOSHINO Takuya, KUSUDA Takeo, MAEDA Kazuo, WATANABE Yoshiyuki, KAWAI Keiichi

doi:10.11280/gee1973b.48.12

[Background] Endoscopic sbmucosal dissection (ESD) is a new therapeutic technology for the treatment of early gastric cancer, which enables higher rates of successful en-block resection than those with conventional endoscopic mucosal resection (EMR) technique. [Methods] A decision analysis comparing ESD with conventional EMR for the treatment of early gastric cancer according to the indication recommended by Japanese Gastric Cancer Association under Japanese health insurance scheme was performed using a decision tree model. The time period studied was 3 years and social perspective was chosen. Probabilities of clinical events were estimated from meta-analyses. [Results] ESD was consistently superior to conventional EMR with regard to clinical outcomes for the patient. Since the formal technical fee for ESD procedure is not yet given under current Japanese health insurance scheme, a threshold analysis was performed on the technical fee for ESD procedure to identify how this variable must change in order for both strategies to be equal on total direct medical costs. This analysis indicated that the threshold technical fee for ESD procedure was 209, 061 yen in base case analyses. Extensive sensitivity analyses disclosed that the cost-effectiveness of ESD was sensitive to the rates of curative en -block resection. [Conclusions] ESD is superior to conventional EMR with regard to both clinical outcomes and cost-effectiveness under the estimated threshold technical fee for ESD in this analysis and therefore, is the preferred therapeutic technique for the treatment of early gastric cancer. Hence, we strongly recommend that an appropriate formal technical fee for ESD should be given under Japanese health insurance scheme on the ground of the results of this study, since the diffusion of ESD means the improvement of clinical outcomes as well as the reduction of medical costs for the treatment of early gastric cancer. A proper training program is necessary to ensure the quality of ESD procedure in order to maintain its advantage.

A CLINICAL DECISION ANALYSIS TO ASSESS THE VALUE OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR THE TREATMENT OF EARLY GASTRIC CANCER WITH RESPECT TO CLINICAL OUTCOMES AND COST-EFFECTIVENESS

Bibliographic Information

Search this article

Description

Journal

Citations (1)*help

References(35)*help

Keywords

Details 詳細情報について

Export

Report a problem