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News
A new cost-effectiveness analysis finds that cold endoscopic mucosal resection (C-EMR) is the more economical choice over hot EMR (H-EMR) for removing large colorectal polyps. Despite H-EMR's lower recurrence rates, its higher complication risks drive up costs — giving C-EMR a near 100% probability of being cost-effective at standard thresholds.
The case for going cold in the procedure room
A new cost-effectiveness analysis published in the Journal of Clinical Gastroenterology finds that cold endoscopic mucosal resection (C-EMR) is the better economic choice over hot EMR (H-EMR) for managing large nonpedunculated colorectal polyps (LNPCPs) 15 mm or larger. While H-EMR has long been the preferred approach due to its lower recurrence rates, its higher rates of serious complications — like delayed bleeding and perforation — end up costing more overall.
The analysis pooled data from four randomized trials involving 1,442 patients and 1,516 LNPCPs. Researchers ran 10,000 simulations and found C-EMR was less costly and more effective in the majority of scenarios, with a near 100% probability of cost-effectiveness at the standard $100,000 per QALY threshold.
By the Numbers
Why it matters: Colorectal polyp removal is one of the most common GI procedures performed, meaning even modest per-patient savings can add up significantly across health systems. This analysis gives clinicians and payers a strong economic case to consider C-EMR as the preferred technique for large polyps.
