S463 Hot-EMR vs Cold-EMR for Large Non-Pedunculated Colorectal Polyps: A Cost-Effectiveness Analysis

Introduction: Hot endoscopic mucosal resection (H-EMR) is the standard approach for resecting large non-pedunculated colorectal polyps (LNPCPs), offering deeper tissue excision and lower recurrence rates. However, H-EMR is also associated with higher adverse event risks, particularly delayed post-polypectomy bleeding (DPPB). Cold EMR (C-EMR) has emerged as a safer, non-thermal alternative with reduced bleeding risk, yet its higher recurrence rates remain a concern. Given these trade-offs, this study assesses the cost-effectiveness of H-EMR vs C-EMR for LNPCPs using pooled data from randomized controlled trials and decision modeling. Methods: We conducted an incremental cost-effectiveness analysis over a 6-month time horizon using a decision tree model informed by the pooled data of 4 randomized studies evaluating H-EMR vs C-EMR. Costs—including those for EMR, delayed bleeding and hospitalization, as well as repeat colonoscopy with polypectomy in case of recurrence—were derived from CMS reimbursement data and published sources. Incremental cost-effectiveness ratio (ICER) was determined for the base patient undergoing H-EMR vs C-EMR for ≥20 mm LNPCPs. Analysis was performed using TreeAge Pro Healthcare 2024. Results: DPPB was defined as overt bleeding post-procedure, often necessitating transfusion and/or endoscopic intervention. For the Cost-effectiveness analysis of LNPCPs, data from 4 randomized controlled trials comprising 1,516 LNPCPs (750 H-EMR; 766 C-EMR) in 1,442 patients was utilized. In the base case of a 66.8-year-old patient undergoing endoscopic resection for LNPCPs, Hot-EMR was associated with an incremental cost of -$39.61 and an incremental effectiveness of 0.0001435 quality-adjusted life years (QALYs), yielding an ICER of -$275,905 per QALY, indicating cost-savings with H-EMR compared C-EMR at the accepted willingness-to-pay (WTP) threshold of $100,000 per QALY. Based on 1-way sensitivity analyses, H-EMR remained cost-effective if the (a) rate of DPPB following H-EMR remains below 4.67% (b) recurrence rate following H-EMR remains below 13.49%. Conclusion: At the WTP threshold of $100,000 per QALY, our analysis indicates that H-EMR is cost-effective compared to C-EMR for the resection of LNPCPs. While H-EMR carries a modestly higher risk of DPPB, its substantially lower recurrence rate leads to considerable economic benefits. Given the favorable economic profile of H-EMR, it may be the preferred strategy in appropriate patients undergoing resection of LNPCPs.