Cold EMR for Large Nonpedunculated Colon Polyps Dominates Hot EMR in Cost-Effectiveness Analysis
Douglas K. Rex, MD, MASGE, reviewing Mehta DL, et al. Endoscopy 2021 Mar 29.
Cold EMR is becoming increasingly popular for large nonpedunculated colorectal lesions, particularly sessile lesions and adenomas without major 1s or pseudodepressed components. These researchers performed a cost analysis assuming that hot EMRs underwent prophylactic clip closure, the recurrence rates were 15.4% with cold EMR and 5% with hot EMR, patients underwent 2 surveillance colonoscopies 6 and 18 months after EMR, and 70% of large nonpedunculated lesions were candidates for cold EMR. With this model, cold EMR resulted in a $955 lower cost ($5213 vs $6168) and slightly fewer productive days lost (6.2 vs 6.3 days).
In sensitivity analyses, cold EMR remained more cost-effective over a range of recurrence rates; recurrence is typically the major concern with the use of cold EMR. Cost differences between the arms were most sensitive to the cost of clips and the assumed perforation rate and less affected by the bleeding rate and, in particular, the recurrence rate.
COMMENTThe most interesting aspect of cost-effectiveness analyses of this type is which parameters and assumptions most affect the results. For cold EMR, the major clinical concern is the recurrence rate, which is currently being addressed in 2 large ongoing trials. This model finds that variations in the recurrence rate have little impact on the relative cost-effectiveness of hot versus cold EMR. This finding will be of value in considering the results of the randomized trials.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Mehta DL, Loutfy A, Kushnir VM, Faulx A, Smith ZL. Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis. Endoscopy 2021 Mar 29. (Epub ahead of print) (https://doi.org/10.1055/a-1469-2644)
