BACKGROUND AND AIMS Clip closure of the mucosal defect after resecting large (≥20 mm) nonpedunculated colorectal polyps reduces postprocedure bleeding and is cost saving for payers. Clip costs are not reimbursed by payers, posing a major barrier to adoption of this technique in the community. We aimed to determine appropriate clip costs to support broader use of this procedure in practice. METHODS We performed budget impact analysis using our recent decision analytic model, comparing prophylactic clip closure with no clip closure on national cost and outcomes data, to determine the maximum feasible clip price while maintaining cost savings in practice. Sensitivity analyses were performed on important clinical factors. RESULTS In the original model, the baseline postprocedure bleeding risk was 6.8%, increasing cost of care by $614.11 averaged among all patients undergoing large polyp resection without clip closure. Prophylactic clip closure of only large right-sided polyps reduced postprocedure bleeding risk by 70.7% but resulted in cost saving only if the price of clips was $100 or less. Comparatively, prophylactic clip closure of large left-sided polyps had no clinical benefit and was not cost saving. Clip closure strategies focused only on extra-large polyps (≥40 mm), or patients taking antithrombotics regardless of polyp characteristics, were only minimally cost saving. Cost savings and maximum tolerated clip prices depended on medical comorbidity, which directly influences the costs of care to manage postprocedure bleeding. CONCLUSIONS Prophylactic clip closure after endoscopic resection of large colon polyps, particularly those in the right colon segment, is cost saving but requires clip costs less than $100. Translating these findings into practice requires gastroenterology practices to obtain reimbursement from payers for improved clinical outcomes and to align commercial clip prices with this clinical indication.

中文翻译：

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重视创新的内窥镜技术：内窥镜切除大结肠息肉后预防性闭合夹。

背景与目的切除大的（≥20 mm）无蒂大肠息肉后粘膜缺损的夹子闭合减少了术后出血，为付款人节省了成本。付款人无法偿还剪辑费用，这在社区中采用该技术构成了主要障碍。我们旨在确定适当的剪辑成本，以支持在实践中更广泛地使用此程序。方法我们使用最近的决策分析模型进行了预算影响分析，比较了预防性封套关闭与不封套的国家成本和结果数据，以确定最大可行的封套价格，同时又在实践中节省了成本。对重要的临床因素进行了敏感性分析。结果在原始模型中，基线术后出血风险为6.8％，护理费用增加了614美元。在没有夹钳闭合的大息肉切除术患者中，平均11例。仅对大的右侧息肉进行预防性钳夹术可使术后出血风险降低70.7％，但仅在其价格在100美元以下时，才可以节省成本。相比之下，大面积左侧息肉的预防性夹闭术没有临床益处，也没有节省成本。夹子闭合策略仅针对超大型息肉（≥40 mm），或者无论息肉特征如何服用抗栓剂的患者，其节省的成本都很少。成本节省和最大耐受夹价格取决于医疗合并症，这直接影响处理术后出血的护理费用。结论内镜切除大结肠息肉，尤其是右结肠段的息肉后，预防性闭合夹闭，节省了成本，但剪辑成本不到100美元。将这些发现转化为实践需要胃肠病学实践，以从付款人处获得报销，以改善临床结果，并使商业价格与该临床适应症保持一致。