Ahmad Rami, Vaz Osborne P, Boochoon Laken, Korontzi Maria, Wolstenholme Caroline, Obeidallah Rami
General Surgery, East Lancashire Teaching Hospitals NHS Trust, Blackburn, GBR.
Upper Gastrointestinal and General Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Cheshire, GBR.
Cureus. 2025 Jun 16;17(6):e86152. doi: 10.7759/cureus.86152. eCollection 2025 Jun.
The optimal timing of interventional radiology (IR) drainage in patients with necrotizing pancreatitis remains uncertain. This study compares the cost-effectiveness of early (five to six weeks) vs. late (> six weeks) IR drainage using a decision analysis model.
A retrospective cohort of 76 patients with severe necrotizing pancreatitis (2017-2021) was screened. Twenty-two patients met the inclusion criteria and were included in a decision analysis model; 11 underwent early IR drainage and 11 underwent late IR drainage. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A budget impact analysis was also conducted.
Early IR drainage was associated with shorter ICU stays (mean 17 vs. 26 days, p=0.01) and fewer IR drainage sessions (median 12 vs. 28, p=0.04) compared to late drainage. Readmissions were fewer in the early group (four vs. eight; p=0.31), although this difference was not statistically significant. Rates of surgery, including ischemia or fistula, disconnected pancreatic duct syndrome, and bleeding complications, were comparable between groups. Total costs were lower in the early drainage group (£23,533-£48,526) vs. the late group (£29,168-£56,110), with slightly higher QALYs (1.77 vs. 1.76 years). The ICER for early drainage was £15,340.96 per QALY gained, within accepted UK willingness-to-pay thresholds. The budget impact analysis projected annual healthcare savings of £75,835 with early intervention.
In this small decision analysis, IR drainage at five to six weeks demonstrated cost-effectiveness advantages, with significantly shorter ICU stays, fewer drainage procedures, reduced costs, and similar complication rates compared to drainage after six weeks. Larger prospective studies are needed to validate these findings and guide clinical practice.
坏死性胰腺炎患者介入放射学（IR）引流的最佳时机仍不确定。本研究使用决策分析模型比较早期（五至六周）与晚期（>六周）IR引流的成本效益。
筛选了一组2017 - 2021年的76例重症坏死性胰腺炎患者的回顾性队列。22例患者符合纳入标准并被纳入决策分析模型；11例接受早期IR引流，11例接受晚期IR引流。计算成本、质量调整生命年（QALY）和增量成本效益比（ICER）。还进行了预算影响分析。
与晚期引流相比，早期IR引流与ICU住院时间缩短（平均17天对26天，p = 0.01）和IR引流次数减少（中位数12次对28次，p = 0.04）相关。早期组的再入院人数较少（4例对8例；p = 0.31），尽管这种差异无统计学意义。两组之间包括缺血或瘘、胰腺导管离断综合征和出血并发症在内的手术发生率相当。早期引流组的总成本（23,533英镑 - 48,526英镑）低于晚期组（29,168英镑 - 56,110英镑），QALY略高（1.77年对1.76年）。早期引流的ICER为每获得一个QALY 15,340.96英镑，在英国可接受的支付意愿阈值范围内。预算影响分析预计早期干预每年可节省医疗保健费用75,835英镑。
在这项小型决策分析中，五至六周时进行IR引流显示出成本效益优势，与六周后引流相比，ICU住院时间显著缩短、引流程序减少、成本降低且并发症发生率相似。需要更大规模的前瞻性研究来验证这些发现并指导临床实践。
