Health Economic Assessment of Using Single-Operator Direct Visualization Cholangioscopy in the Management of Complex Bile Duct Stones in Saudi Arabia
Author(s)
Murtada Alsaif, PhD, MSc1, Clémence Mignon, MSc2, Kim Seemann, MSc3, Emily Woodward, BA, MSc4, Inma Roig Martinez, MSc5.
1Boston Scientific, Riyadh, Saudi Arabia, 2Boston Scientific, Voisins-le-Bretonneux, France, 3Coreva Scientific GmbH & Co.KG, Koenigswinter, Germany, 4Boston Scientific, Dubai, United Arab Emirates, 5Boston Scientific, Madrid, Spain.
1Boston Scientific, Riyadh, Saudi Arabia, 2Boston Scientific, Voisins-le-Bretonneux, France, 3Coreva Scientific GmbH & Co.KG, Koenigswinter, Germany, 4Boston Scientific, Dubai, United Arab Emirates, 5Boston Scientific, Madrid, Spain.
OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in Saudi Arabia as part of treatment for conditions of the pancreato-biliary system, such as bile-duct stones. Direct visualization with cholangioscopy of the target pathology during procedures for stone removal has been demonstrated to optimize treatment and increase success rates for complete stone extraction. This study assessed the cost-consequence of switching from ERCP only to ERCP plus single-operator cholangioscopy guided lithotripsy (SOC) for complex biliary stones.
METHODS: A health-economic model was developed in Excel® comparing SOC to ERCP-based mechanical lithotripsy for complex bile-duct stones. A decision-tree was used to capture the in-hospital management and procedure outcomes. The model time horizon was one year and took the perspective of the Saudi Arabian public payer. Inputs were informed by peer-reviewed literature and expert interviews. Costs were reported in 2023 Saudi Arabian Riyals (SAR).
RESULTS: The use of SOC was found to be cost saving with a total cost reduction of 3,481,691 SAR over the 475 annual patients. Savings were driven by a reduced number of subsequent procedures (-408) with SOC and a reduction in surgeries having to be performed due to failed stone removal. These reduced from 99 with ERCP to 0 with SOC. Furthermore, the use of SOC demonstrated a reduction in waste generated as well as CO2 emitted through procedures. This was mainly driven by the fact that no surgeries had to be performed in the SOC arm. Results were robust to changes during sensitivity analyses.
CONCLUSIONS: Incorporating SOC in the management of complex bile duct stones reduces the number of procedures required per patient, offering a cost-effective alternative to traditional ERCP for the Saudi Arabian public payer. Additionally, the use of SOC could potentially contribute to environmental sustainability by reducing medical waste and lowering CO2 emissions, reducing the environmental impact of the healthcare system.
METHODS: A health-economic model was developed in Excel® comparing SOC to ERCP-based mechanical lithotripsy for complex bile-duct stones. A decision-tree was used to capture the in-hospital management and procedure outcomes. The model time horizon was one year and took the perspective of the Saudi Arabian public payer. Inputs were informed by peer-reviewed literature and expert interviews. Costs were reported in 2023 Saudi Arabian Riyals (SAR).
RESULTS: The use of SOC was found to be cost saving with a total cost reduction of 3,481,691 SAR over the 475 annual patients. Savings were driven by a reduced number of subsequent procedures (-408) with SOC and a reduction in surgeries having to be performed due to failed stone removal. These reduced from 99 with ERCP to 0 with SOC. Furthermore, the use of SOC demonstrated a reduction in waste generated as well as CO2 emitted through procedures. This was mainly driven by the fact that no surgeries had to be performed in the SOC arm. Results were robust to changes during sensitivity analyses.
CONCLUSIONS: Incorporating SOC in the management of complex bile duct stones reduces the number of procedures required per patient, offering a cost-effective alternative to traditional ERCP for the Saudi Arabian public payer. Additionally, the use of SOC could potentially contribute to environmental sustainability by reducing medical waste and lowering CO2 emissions, reducing the environmental impact of the healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE490
Topic
Economic Evaluation, Medical Technologies
Disease
Gastrointestinal Disorders