Prophylactic clipping versus no clipping after endoscopic mucosal resection of large non-pedunculated colon polyps: a cost-effectiveness analysis - 11/06/25

Doi : 10.1016/j.gie.2025.04.028

Sneh Sonaiya, MD, MPH, MBA ¹, Raj Patel, MD ², Charmy Parikh, MD ³, Magnus Chun, MD ¹, Amrit Narwan, MD ¹, Karan Yagnik, MD ⁴, Pranav Patel, MD ⁵, Bradley Confer, MD ⁵, Harshit Khara, MD ⁵, Babu P. Mohan, MD ^6,^7,^⁎
¹ Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
² Department of Internal Medicine, St. Mary Medical Center, Langhorne, Pennsylvania, USA
³ Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
⁴ Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
⁵ Department of Gastroenterology & Hepatology, Geisinger Health, Danville, Pennsylvania, USA
⁶ University of Central Florida School of Medicine, Orlando, Florida, USA
⁷ Orlando Gastroenterology PA, Orlando, Florida, USA

^∗Corresponding author: Babu P. Mohan, MD, Orlando Gastroenterology PA, University of Central Florida School of Medicine, 1507 S Hiawassee Rd, STE 105, Orlando, FL 32835.University of Central Florida School of MedicineOrlando Gastroenterology PA1507 S Hiawassee RdSTE 105OrlandoFL32835

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 11 June 2025

Abstract

Background and Aims

Delayed post-polypectomy bleeding (DPPB) is an established adverse event after EMR of large non-pedunculated colon polyps (LNPCPs). Although clipping is commonly used in clinical settings, particularly for LNPCPs and for patients on antithrombotic agents, the cost-effectiveness of prophylactic clipping is not well studied.

Methods

We conducted an incremental cost-effectiveness analysis comparing prophylactic clipping (PC) versus no clipping (NC) for DPPB over a 1-year time horizon using a Markov decision tree model based on pooled randomized controlled trial data. Costs for hemostatic clips, hospitalization, and EMR were derived from Centers for Medicare & Medicaid Services reimbursement data and published literature. Analysis was performed by using TreeAge Pro Healthcare 2024.

Results

Pooled data from 4557 patients (2288 PC; 2269 NC) were analyzed. For a base case of a 65-year-old patient undergoing EMR of ≥20 mm proximal LNPCP, PC resulted in an incremental cost-effectiveness ratio (ICER) of –$154,706, indicating cost savings. For very large (≥40 mm) LNPCPs, PC was cost-effective compared with NC, with an ICER of $83,894. Among patients with LNPCPs on antithrombotic therapy, PC was cost-saving when up to 2 clips were used, with an ICER of –$120,561. For proximal LNPCPs, PC remains cost-effective when per-clip cost is below $217 or <4 clips are used.

Conclusions

At a willingness-to-pay threshold of were$100,000 dollars per quality-adjusted life year, PC is cost-saving for proximal LNPCPs, cost-effective for very large (≥40 mm) LNPCPs, and cost-saving for patients with LNPCPs on antithrombotic agents. Reducing clip costs (≤$217) and optimizing usage (≤4 clips) further improve economic viability of PC.

Le texte complet de cet article est disponible en PDF.

Abbreviations : DPPB, ICER, LNPCP, NC, PC, QALY, QoL, RCT, WTP