Cost-effectiveness of follow-up invasive coronary angiography after percutaneous coronary stenting: a real-world observational cohort study in Japan

Comparative analysis of different biopsy techniques for pancreatic lesions in diagnostic value, safety, and cost-effectiveness

Background

Pancreatic cancer is highly lethal and often diagnosed at an advanced stage, highlighting the need for early and accurate diagnosis. Although imaging plays a crucial role, definitive pathological confirmation requires biopsy. Percutaneous ultrasound-guided core needle biopsy (US-CNB), computed tomography-guided core needle biopsy (CT-CNB), and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are the three main biopsy techniques, each differing in diagnostic accuracy, safety, and cost-effectiveness. The aim of this study was to compare the diagnostic value, safety, and cost-effectiveness of these three biopsy techniques for suspiciously malignant pancreatic lesions.

Methods

We retrospectively evaluated patients with suspicious malignant pancreatic lesions who underwent US-CNB, CT-CNB, or EUS-FNA from January 2018 to January 2023. We compared technical success rates, sample adequacy, diagnostic accuracy, sensitivity, specificity, and complication rates of three groups. Additionally, we calculated the cost/effectiveness ratio (C/E) and incremental cost-effectiveness ratio (ICER) for each method.

Results

A total of 399 patients were enrolled (US-CNB, n=86; CT-CNB, n=55; EUS-FNA, n=258), achieving 100% technical success. Sample adequacy satisfaction rates were 97.70% for US-CNB, 90.90% for CT-CNB, and 74.03% for EUS-FNA, with EUS-FNA significantly lower compared to the other two methods (P<0.001). Diagnostic accuracy was significantly higher for US-CNB (97.70%) and CT-CNB (90.90%) compared to EUS-FNA (69.80%) (P<0.001). Complication rates were 15.12% for US-CNB, 16.36% for CT-CNB, and 10.47% for EUS-FNA, with no significant differences (P=0.319). Compared to EUS-FNA, ICER for US-CNB was -14,367.7 yuan and for CT-CNB was -8,279.22 yuan per correct diagnosis, both below the willingness-to-pay threshold.

Conclusions

US-CNB and CT-CNB demonstrate superior diagnostic accuracy and specimen adequacy compared to EUS-FNA for suspected malignant pancreatic lesions. There are no significant differences in postoperative complication rates among three biopsy methods. In terms of cost-effectiveness, US-CNB and CT-CNB have lower costs and higher effectiveness than EUS-FNA, indicating greater economic efficiency.

Trends in the cost-effectiveness level of percutaneous coronary intervention: Macro socioeconomic analysis and health technology assessment

Percutaneous coronary intervention (PCI), one of the most prevalent techniques of revascularization, is a procedure that remarkably improves treatment outcomes. However, it consumes large amounts of medical resources and has resulted in an increased socioeconomic burden due to the increasing number of target patients. In recent years, there have been sporadic discussions, both in Japan and other countries, regarding the optimization of interventions and the perspective of medical economics. Based on this, previous studies on PCI-related cost-effectiveness were reviewed in order to consider the current level of medical economics regarding PCI. Using the databases MEDLINE and EMBASE, a survey involving data from original articles and systematic reviews was conducted from January 2010 to August 2022. Conditions were not imposed on the evidence level due to the paucity of studies, although field studies were prioritized over simulation studies. The macro medical economics of acute myocardial infarction treatment, which is the primary target of PCI, were generally at an average level when compared to those in other countries; however, there is room for further improvement in Japan's performance. Revascularization in a population with multivessel coronary artery disease showed that coronary artery bypass graft surgery tended to be more cost-effective than PCI in the long-term setting. However, it was suggested that PCI may be more cost-effective in patients with SYNTAX Score ≤22 or left main artery disease. A cost-effectiveness report for stable angina patients was not in favor of PCI over medical therapy. Moreover, there were some reports showing the medical economic superiority of early myocardial ischemia evaluation, and it was foreseen that active selection of patients will contribute to the improvement of the overall cost-effectiveness of PCI. In order to further improve the socioeconomic significance of PCI in the future, it is necessary to aim for harmony between clinical practice and health economics.