| Theme |
Therapeutic Strategy for Early Gastrointestinal Cancers with EMR or ESD |
| Title |
ESD vs. Conventional EMR for Treatment of Early Gastric Cancer -- A Cost-effectiveness Analysis |
| Author |
Yasuki Habu |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Hiroshi Hisatsune |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Ryutaro Maruoka |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Shigeto Mizuno |
Department of Medical Pharmaceutics, Kobe Pharmaceutical University |
| Author |
Yoshiyuki Watanabe |
Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science |
| Author |
Keiichi Kawai |
Digestive Clinical Outcomes Research Group |
| [ Summary ] |
Endoscopic submucosal dissection (ESD) is a new therapeutic technology, which enables higher rates of successful en-block resection than those with conventional endoscopic mucosal resection (EMR). A decision analysis comparing ESD and conventional EMR for the treatment of early gastric cancer under the Japanese health insurance scheme was performed using a decision tree model. The time period studied was 3 years and a social perspective was chosen. Probabilities of clinical events were estimated from meta-analyses. ESD was consistently superior to conventional EMR in regard to both clinical outcomes and cost-effectiveness within the plausible range of probabilities, according to the sensitivity analyses. Since the cost-effectiveness was sensitive to rates of curative en-block resection, threshold analysis was performed on this variable for conventional EMR to identify how this variable must change in order for both strategies to be equal in terms of total costs. This analysis indicated that the threshold rate for conventional EMR was 81 %, when the probability for ESD was assumed to be 96 % (base case analyses). ESD is superior to conventional EMR and therefore, is the preferred therapeutic technique for treatment of early gastric cancer. From the perspective of cost-effectiveness, the indications for conventional EMR should be limited to cases in which the expected curative en-block resection rate is rather high (over 80 %). |