Abstract :
Background: Endoscopic biliary drainage (EBD) using metal stent, percutaneous transhepatic biliary
drainage (PTBD) and palliative care are treatment options for patients with unresectable hilar cholangiocarcinoma
(HCA). The information about their cost effectiveness is not available. The aim of this study was to compare the
cost utility of EBD or PTBD to palliative care.
Methodology: Cost and quality-adjusted life year (QALY) of EBD, PTBD and palliative care group
were evaluated by decision analytic model (Markov model). Cost of treatment and utility of each Markov state
were derived from hospital charges and previous quality of life study respectively. Transition probabilities were
derived from international literature and cholangiocarcinoma registry database from tertiary care hospitals in Thailand.
Base-case and sensitivity analyses were performed.
Results: Compared with palliative care, an incremental cost per additional QALY gained of EBD and
PTBD were 655,520 baht (US$19,976) and 6,548,398 baht (US$199,549), respectively. From probabilistic sensitivity
analysis, EBD is preferable than palliative care if the willingness to pay (WTP) is higher than 650,000 baht
(US$19,807). PTBD is not cost-effective compared with palliative care at any WTP threshold.
Conclusion: EBD is more cost effective than PTBD when compared with palliative care in unresectable
HCA.
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file/Thai-Journal-of-gastroenterology-vol-16-no-3-600237.pdf