Cost of Endoscopic Submucosal Dissection Versus Endoscopic Piecemeal Resection in the Colorectum

Abstract

Background Few studies have compared the costs of colorectal endoscopic submucosal dissection (ESD) and endoscopic piecemeal mucosal resection (EPMR). Aims Here, we aimed to investigate the cost-effectiveness of these approaches by analyzing clinical outcomes and costs. Methods Data from patients undergoing colorectal ESD and EPMR were retrospectively reviewed. Clinical outcomes (procedure time, complete resection, and recurrence) were compared, and total direct costs (procedural and follow-up) were assessed. Results Data from 429 ESD and 115 EPMR patients were included in the analysis. The complete resection rate was significantly higher (83.9% vs. 32.2%, p < 0.001), recurrence rate was lower (0.5% vs. 7.1%, p < 0.001), procedure time was longer (55.4 +/- 47.0 vs. 25.6 +/- 32.7 min, p < 0.001), and total direct procedural costs at the initial resection were higher (1480.0 +/- 728.0 vs. 729.8 +/- 299.7 USD, p < 0.001) in the ESD group than in the EPMR group. The total number of surveillance endoscopies was higher in the EPMR group (1.7 +/- 1.5 vs. 1.3 +/- 1.1, p = 0.003). The cumulative total costs of ESD and EPMR were comparable at 3 and 2 years' follow-up in the adenoma and mucosal/superficial submucosal cancer subgroups, respectively. Conclusions Colorectal ESD was associated with higher complete resection and lower recurrence rates. EPMR showed shorter procedure times and similar cumulative total direct costs. ESD or EPMR should be chosen based on both clinical outcomes and cost-effectiveness.