Thiruvengadam NR, Saumoy M, Schneider Y, et al. - In both average-risk and high-risk patients undergoing ERCP, rectal indomethacin was the cost-effective method for preventing post-ERCP pancreatitis (PEP). When compared with no-prophylaxis, all strategies were cost-effective in high-risk patients, while all strategies except aggressive hydration with lactated ringers were cost-effective in average-risk patients.

• At a WTP of $100,000, all strategies were cost-effective in preventing PEP in high-risk patients when compared with no prophylaxis.

• In a direct comparison, rectal indomethacin was the most cost-effective strategy in high-risk patients ($31,589/QALY).

• In average-risk patients, indomethacin and sublingual nitrates were more cost-effective than no prophylaxis at a WTP of $100,000/QALY.

• When the two strategies were directly compared, rectal indomethacin was the most cost-effective ($53,016/QALY).