How to avoid overtreatment of benign colorectal lesions: Rationale for an evidence-based management

Table 2 Cost-effectiveness studies, endoscopic therapy vs surgery

Ref.	Year	Country	Endoscopic technique	Design	Comparison	Costs analyzed	Results
Swan et al[19]	2009	Australia	EMR	Observational monocentric	Endoscopy vs surgery, Considering surgery without major complications	Direct costs including a 1-day hospital stay for EMR, Loss of utility not considered	EAC: $2051 pp, SAC: $9041
Jayanna et al[16]	2016	Australia	EMR	Observational multicentric	Endoscopy vs surgery, Considering surgery with and without complications	Direct costs including hospital stay and adverse events, 1st surveillance endoscopy	EAC: $4668 pp, SAC: $12720, If surgery 7.5% complications -> SAC: $45530
Law et al[17]	2016	USA	EMR	Decision analysis tree (hybrid Markov model)	Endoscopy (resection + surveillance, surgery if recurrence at 12 mo) vs laparoscopic surgery, Considering complications in both arms	Direct costs, Loss of utility considered, QALY, Sensitivity analysis	EAC: $5570 ppEndoscopy QALY: 9.64, SAC: $18717 pp, Surgery QALY: 9.58, Laparoscopy is cost-effective if complete EMR < 75.8%, EMR adverse events rate > 12% and laparoscopy cost < $14.000
Dahan et al[18]	2019	France	ESD	Observational monocentric	Endoscopy vs surgery, Considering complications in both arms	Direct costs including hospital stay and endoscopy costs	EAC: €3190, SAC: €8490
Buskermolen et al[13]	2022	Netherlands	Non-specified	Microsimulation screening analysis (MISCAN-colon)	Surgery vs attempted removal by an expert endoscopist, Considering complications in both arms	Direct costs, Loss of utility considered, QALY, Sensitivity analysis	EAC: €60.200, SAC: €72.700, Endoscopy QALY: 33.1/1000 individuals, Surgery QALY: 32.9/1000 individuals

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosa dissection; QUALY: Quality adjusted life years; EAC: Endoscopy average cost; SAC: Surgical average cost; pp: Per patient.