Economic Evaluation of Palliative Biliary Drainage in Unresectable Hilar Cholangiocarcinoma
Tanita Suttichaimongkol MD1, Schlermbhol Borntrakulpipat MD2, Apichat Sangchan MD3, Pisaln Mairiang MD4, Eimorn Mairiang MD5, Wattana Sukeepaisarnjaroen MD1, Kitti Chunlertlith MD1, Kookwan Sawadpanich MD1
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Department of Medicine, Kalasin Hospital, Kalasin, Thailand 3 Department of Medicine, Bangkok Khon Kaen Hospital, Khon Kaen, Thailand 4 GI Endoscopy Srinagarind Center of Excellence, Srinagarind Hospital, Khan Kaen, Thailand 5 Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : The current treatment options available for patients with unresectable hilar cholangiocarcinoma [CCA] are
endoscopic biliary drainage [EBD] using a metal stent, percutaneous transhepaticbiliary drainage [PTBD], and palliative
care. However, information regarding their cost-effectiveness is not available.This study aimed to compare the cost utility
between palliative biliary drainage [EBD or PTBD] and palliative care.
Materials and Methods : We used 2 methods for evaluation, direct calculation and the Markov decision analysis model. The
cost of treatment and quality-adjusted life years [QALY] in the EBD, PTBD and palliative care groups were collected from
the cohorts of unresectable hilar CCA database at a tertiary care hospital in Thailand. Transition probabilities were derived
from international literature and the cohorts. Base-case and sensitivity analysis was also performed.
Results : Compared with palliative care, the incremental cost per additional QALY gained from EBD and PTBD using the
direct calculation method were 422,822 baht (US$ 12,622) and 490,578 baht (US$ 14,644) per QALY gained, respectively.
This result was in concordance with the Markov model. The ICER from EBD and PTBD were 655,520 baht (US$19,568)
and 6,548,398 baht (US$195,475) per QALY gained, respectively. According to probabilistic sensitivity analysis using the
Markov model, EBD is preferable to palliative care if the willingness to pay [WTP] is higher than 650,000 baht (US$19,403)
per QALY gained. PTBD is not cost-effective compared to palliative care at any WTP threshold. At a WTP threshold of
160,000 Thai baht (the threshold of Thailand; US$ 4,776 per QALY gained) neither EBD nor PTBD were found to be cost-
effective. At this threshold, only palliative care is cost-effective.
Conclusion : EBD is more cost-effective than PTBD when compared with palliative care in cases of unresectable hilar CCA,
but at the WTP threshold of Thailand only palliative care is cost-effective.
Keywords : Cost-effectiveness, Cost utility, Endoscopic biliary drainage, Hilar cholangiocarcinoma, Percutaneoustranshepatic biliary drainage, Palliative
