Cost-effectiveness of early laparoscopic cholecystectomy for mild acute gallstone pancreatitis  

Oleh:

Morris, S. ; Gurusamy, K.S. ; Patel, N. ; Davidson, B.R.

Jenis: Article from Article - diterbitkan di jurnal ilmiah internasional
Dalam koleksi: BJS: British Journal of Surgery vol. 101 no. 07 (Jun. 2014), page 828-835.
Topik: laparoscopic cholecystectomy; pancreatitis; gastroenterology; gallstone; patient risks; cost effective

Ketersediaan

Perpustakaan FK Nomor Panggil: B15.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background A recent Cochrane review suggested that laparoscopic cholecystectomy carried out early following mild gallstone pancreatitis was safe. This study compared the cost-effectiveness of laparoscopic cholecystectomy performed within 3?days of admission, during the same admission but after more than 3?days, or electively in a subsequent admission. Methods A model-based cost–utility analysis was performed estimating mean costs and quality-adjusted life-years (QALYs) per patient in the UK National Health Service with a 1-year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources for mild gallstone pancreatitis, including one-way and probabilistic sensitivity analyses. Results The costs of laparoscopic cholecystectomy performed within 3 days of admission, beyond 3?days but in the same admission, and electively in a subsequent admission were €2748, €3543 and €3752 respectively; the QALYs were 0·888, 0·888 and 0·884 respectively. Early laparoscopic cholecystectomy had a 91 per cent probability of being cost-effective at the maximum willingness to pay for a QALY commonly used in the UK. It is acknowledged that many hospitals do not have access to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, especially at weekends, and that implementing a 3-day target is unrealistic without allocating new resources that could erode the cost-effectiveness. Conclusion Performing laparoscopic cholecystectomy for mild gallstone pancreatitis within 3?days of admission is cost-effective, but may not be feasible without significant resource allocation. After 3?days there is little financial advantage to same-admission operation.

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