A86 COST-EFFECTIVE ANALYSIS OF PRELIMINARY SINGLE-OPERATOR CHOLANGIOSCOPY IN MANAGEMENT OF DIFFICULT STONES
Bibliographic record
Abstract
Abstract Background Single-operator peroral cholangioscopy (POC) is a therapeutic modality for difficult biliary stone disease. Given its high success rate and increasing availability, analysis of the economic impact of early POC utilization is critical for clinical decision-making. Aims We aim to compare the cost-effectiveness of different first and second-line endoscopic modalities for difficult-to-treat choledocholithiasis. Methods A decision tree model with a 1-year time horizon and a hypothetical cohort of 200 patients was used to analyze the cost-effectiveness of POC for first, second and third-line intervention in presumed difficult biliary stones. We adopted the perspective of a Canadian tertiary hospital, omitting complications and recurrence rates associated with ERCP. Effectiveness estimates were obtained from updated meta-analyses. One-way sensitivity analyses and probabilistic sensitivity analyses were also performed to assess how changes in key parameters affected model conclusions. Results First and second-line POC achieved comparable clinical efficacy from 95.5% to 96.5% stone clearance. The least expensive strategy is third-line POC (POC-3: $769,151). Performing POC during the second ERCP was marginally more expensive (POC-2: $770,832) but 9% more effective. The strategy of first-line POC incurred the highest hospital expenditures (POC-1: $848,141) but decreased total procedures performed by 13.4% when compared with POC-2. Sensitivity analysis was robust in showing POC-2 as the most optimal approach. Conclusions Second-line POC was superior to first and third-line POC for treatment of difficult biliary stones. When based on meta-analysis of non-heterogeneous trials, POC-2 is more cost-effective and cost-efficient. Our study warrants a larger pragmatic effectiveness trial. Funding Agencies None
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".