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Inpatient Choledocholithiasis Management: a Cost-Effectiveness Analysis of Management Algorithms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Choledocholithiasis is commonly encountered. It is frequently managed with laparoscopic common bile duct exploration or endoscopic retrograde cholangiopancreatography (either preoperative, intraoperative, or postoperative relative to laparoscopic cholecystectomy). The purpose of this study is to determine the most cost-effective method to manage inpatient choledocholithiasis.

Methods

A decision tree model was created to evaluate the cost-effectiveness of laparoscopic common bile duct exploration and preoperative, intraoperative, and postoperative endoscopic retrograde cholangiopancreatography. The primary outcome was incremental cost-effectiveness ratio with a ceiling willingness to pay threshold assumed of $100,000 per quality-adjusted life year. Model parameters were determined through review of published literature and institutional data. Costs were from the perspective of the healthcare system with a time horizon of 1 year. Sensitivity analyses were performed on model parameters.

Results

In the base case analysis, laparoscopic common bile duct exploration was cost-effective, resulting in 0.9909 quality-adjusted life years at an expected cost of $18,357. Intraoperative endoscopic retrograde cholangiopancreatography yielded more quality-adjusted life years (0.9912) at a higher cost ($19,717) with an incremental cost-effectiveness ratio of $4,789,025, exceeding the willingness to pay threshold. Both preoperative and postoperative endoscopic retrograde cholangiopancreatographies were eliminated for being both more costly and less effective. Laparoscopic common bile duct exploration remained cost-effective if the probability of successful biliary clearance was above 0.79, holding all other variables constant. If its base cost remained below $18,400 and intraoperative endoscopic retrograde cholangiopancreatography base cost rose above $18,200, then laparoscopic common bile duct exploration remained cost-effective.

Conclusion

Laparoscopic common bile duct exploration is the most cost-effective method to manage choledocholithiasis. Efforts to ensure availability of local expertise and resources for this procedure are warranted.

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Author information

Authors and Affiliations

  1. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    David J. Morrell, Eric M. Pauli & Christopher S. Hollenbeak

  2. Department of Health Policy and Administration, Pennsylvania State University, State College, University Park, PA, USA

    Christopher S. Hollenbeak

Authors
  1. David J. Morrell
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Contributions

Study design: Morrell, Pauli, and Hollenbeak.

Data collection: Morrell

Data analysis and interpretation: Morrell, Pauli, and Hollenbeak

Manuscript drafting: Morrell

Critical revisions of manuscript: Morrell, Pauli, and Hollenbeak

Corresponding author

Correspondence to David J. Morrell.

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Conflict of Interest

David J. Morrell and Christopher S. Hollenbeak have no conflicts of interest. Eric M. Pauli reports consultant fees and Data and Safety Monitoring Board membership for Becton, Dickinson and Company (BD); consultant fees from Boston Scientific Corp.; consultant fees from Cook Biotech, Inc.; royalties from Springer; royalties from UpToDate, Inc.; consultant fees from Wells Fargo & Company; consultant fees from CMR Surgical; consultant fees from Medtronic, PLC; consultant fees from Ovesco Endoscopy, AG; and consultant fees from Baxter International, Inc., unrelated to this report.

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Morrell, D.J., Pauli, E.M. & Hollenbeak, C.S. Inpatient Choledocholithiasis Management: a Cost-Effectiveness Analysis of Management Algorithms. J Gastrointest Surg 26, 837–848 (2022). https://doi.org/10.1007/s11605-022-05249-5

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  • DOI: https://doi.org/10.1007/s11605-022-05249-5

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