Assessing the impact of center volume on the cost-effectiveness of centralizing ERCP

Background and Aims: ERCP is a complex endoscopic procedure in which the center's ' s procedure volume infl uences outcomes. With the increasing healthcare expenses and limited resources, promoting cost-effective care becomes essential for healthcare provision. This study was a cost-effectiveness analysis to evaluate the hypothesis that high-volume (HV) centers perform ERCP with higher quality at lower costs than low-volume (LV) centers. Methods: A baseline case compared the current distribution of ERCPs among HV and LV centers with a hypothetical scenario in which all ERCPs are performed at HV centers. A cost-effectiveness analysis was constructed, followed by 1and 2-way sensitivity analyses, and probabilistic sensitivity analysis using Monte Carlo simulations. Results: In the baseline case, the incremental cost-effectiveness ratio was - $151,270 per year, due to the hypothetical scenario's ' s lower costs and slightly higher quality-adjusted life years. The model was most sensitive to changes in transportation costs (109.34%), probability of significant fi cant adverse events (AEs) after successful ERCP at LV centers (42.12%), utility after ERCP with significant fi cant AEs (30.10%), and probability of significant fi cant AEs after successful ERCP at HV centers (23.53%); only transportation costs above $3655 changed the study outcome, however. The current ERCP distribution would only be cost-effective if LV centers achieved higher success (>92.4% > 92.4% vs 89.3%), with much lower significant fi cant AEs (<=.5% <= .5% vs 6.7%). The study's ' s main fi ndings remained unchanged while combining all model parameters in the probabilistic sensitivity analysis. Conclusions: Our fi ndings show that HV centers have high-performance rates at lower costs, raising the need to consider the principle of centralization of ERCPs into HV centers to improve the quality of care.