OBJECTIVES : Difficult bile stones are one of important cause of morbidity and mortality, if not diagnosed and treated as needed. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for treatment. Using single-operator cholangioscopy with SpyScope, the new technology serves better ERCP diagnosis and treatment outcomes in difficult bile stones. The aim of the study is to understand the clinic and economic outcomes of SpyScope + ERCP versus standard ERCP in difficult bile stones for Turkey.

METHODS : A decision-tree model was conducted to compare SpyScope + ERCP and standard ERCP with TreeAge 2019 modeling program. Reimbursement agency perspective has been selected with only including direct cost for Social Security Institution, the payer agency. Expert opinion has been retrieved to calculate the cost of both treatment options. Primary end-point was selected as successful diagnose or treatment. Secondary end point was selected as surgical treatment need patient number. Clinical outcomes have been retrieved from published literature. Results have been reported with TreeAge 2019.

RESULTS : It was reported that SpyScope + ERCP approach serves 26% more successful diagnose or treatment and 58% less surgical treatment need patient number versus standard ERCP. Incremental cost for per successful treatment for SpyScope + ERCP approach was reported as 65.872 TL.

CONCLUSIONS : The study found that SpyScope + ERCP approach serves better clinic outcomes in terms of successful diagnose or treatment and less surgical treatment need patient number with an acceptable incremental cost versus standard ERCP. Health professionals and decision makers need to take account include SpyScope in daily clinic routine for diagnose and treatment of difficult bile duct stones in Turkey.