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Surgical Endoscopy

, Volume 27, Issue 1, pp 256–262 | Cite as

Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

  • Amanda Johner
  • Adam Raymakers
  • Sam M. WisemanEmail author
Article

Abstract

Background

Early laparoscopic cholecystectomy for acute cholecystitis is safe and effective. However, the potential cost savings of this management strategy have not been well studied in a North American context. This study aimed to estimate the cost effectiveness of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy in Canada.

Methods

A decision analytic model estimating and comparing costs from a Canadian providing institution after either early or delayed laparoscopic cholecystectomy was used. The health care resources consumed were calculated using local hospital data, and outcomes were measured in quality-adjusted life years (QALYs) gained during 1 year. Uncertainty was investigated with one-way sensitivity analyses, varying the probabilities of the events and utilities.

Results

Early laparoscopic cholecystectomy was estimated to cost approximately $2,000 (Canadian dollars) less than delayed laparoscopic cholecystectomy per patient, with an incremental gain of approximately 0.03 QALYs. Sensitivity analysis showed that only extreme values of bile duct injury or bile leak altered the direction of incremental gain.

Conclusions

Adoption of a policy in favor of early laparoscopic cholecystectomy will result in better patient quality of life and substantial savings to the Canadian health care system.

Keywords

Acute cholecystitis Delayed laparoscopic cholecystectomy Early laparoscopic cholecystectomy 

Notes

Disclosures

Amanda Johner, Adam Raymakers, and Sam M. Wiseman have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Papi C, Catarci M, Ambrosio D, Gili L, Koch M, Grassi GB et al (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99:147–155PubMedCrossRefGoogle Scholar
  2. 2.
    Lawrentschuk N, Hewitt PM, Pritchard MG (2003) Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery. ANZ J Surg 73:890–893PubMedCrossRefGoogle Scholar
  3. 3.
    Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 20:43–48PubMedCrossRefGoogle Scholar
  4. 4.
    Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211PubMedCrossRefGoogle Scholar
  5. 5.
    Senapai PS, Bhattarcharya D, Harinath G, Ammori BJ (2003) A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl 85:306–312CrossRefGoogle Scholar
  6. 6.
    Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150PubMedCrossRefGoogle Scholar
  7. 7.
    Wilson E, Gurusamy K, Gluud C, Davidson BR (2010) Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:210–219PubMedCrossRefGoogle Scholar
  8. 8.
    Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev (4):CD006231Google Scholar
  9. 9.
    Gurusamy KS, Samraj K (2006) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev (4):CD005440Google Scholar
  10. 10.
    Vetrhus M, Soreide O, Nesvik I, Sondenaa K (2003) Acute cholecystitis: delayed surgery or observation: a randomized clinical trial. Scand J Gastroenterol 38:985–990PubMedCrossRefGoogle Scholar
  11. 11.
    Pinkas H, Brady PG (2008) Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int 7:628–632PubMedGoogle Scholar
  12. 12.
    Aboulian A, Chan T, Yaghoubian A, Kaji AH, Putnam B, Stabile BE, de Virgilio C (2010) Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study. Ann Surg 251:615–619PubMedCrossRefGoogle Scholar
  13. 13.
    The Cost-Effectiveness Analysis Registry (2010) http://www.cearegistry.org. Accessed 21 Feb 2010
  14. 14.
    Bass EB, Pitt HA, Lillemoe KD (1993) Cost effectiveness of laparoscopic cholecystectomy versus open cholecystectomy. Am J Surg 165:466–471PubMedCrossRefGoogle Scholar
  15. 15.
    Cook J, Richardson J (2010) Quality of life measurement of patients receiving treatment for gallstone disease: options, issues, and results. Working paper 33. http://www.buseco.monash.edu.au/centres/che/pubc/wp33.pdf. Accessed 3 Mar 2010
  16. 16.
    Arseneau KO, Cohn SM, Cominello F, Connors AF Jr (2001) Cost utility of initial medical management for Crohn’s disease perianal fistulae. Gastroenterology 120:1640–1656PubMedCrossRefGoogle Scholar
  17. 17.
    Moore DR, Feurer ID, Holzman MD, Wudel LJ, Strickland C, Gorden L, Chari R, Wright K, Wright Pinson C (2004) Long-term detrimental effect of bile duct injury on health-related quality of life. Arch Surg 139:476–482PubMedCrossRefGoogle Scholar
  18. 18.
    Ara R, Brazier J (2008) Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies. Value Health 11:1131–1143PubMedCrossRefGoogle Scholar
  19. 19.
    Tzovaras G, Zacharoulis D, Liakou P, Theodoropoulos T, Paroutoglou G, Hatzitheofilou C (2006) Timing of laparoscopic cholecystectomy for acute cholecystitis: a prospective nonrandomized study. World J Gastroenterol 12:5528–5531PubMedGoogle Scholar
  20. 20.
    Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ (2006) Urgent laparoscopic cholecystectomy in the management of acute cholecystitis: timing does not influence conversion rate. Surg Endosc 20:806–808PubMedCrossRefGoogle Scholar
  21. 21.
    Shikata S, Noguchi Y, Fukui T (2005) Early versus delayed cholecystectomy for acute cholecystitis: a meta-analysis of randomized controlled trials. Surg Today 35:553–560PubMedCrossRefGoogle Scholar
  22. 22.
    Garner JP, Sood SK, Robinson J, Barber W, Ravi K (2009) The cost of ignoring acute cholecystectomy. Ann R Coll Surg Engl 91:39–42PubMedCrossRefGoogle Scholar
  23. 23.
    Riall TS, Zhang D, Townsend CM, Kuo YF, Goodwin JS (2010) Failure to perform cholecystectomy for acute cholecystitis in elderly patients in associated with increased morbidity, mortality, and cost. J Am Coll Surg 210:668–676PubMedCrossRefGoogle Scholar
  24. 24.
    Macafee DAL, Humes DJ, Bouliotis G, Beckingham IJ, Whynes DK, Lobo DN (2009) Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg 96:1031–1040PubMedCrossRefGoogle Scholar
  25. 25.
    Papi C, Catarci M, D’Ambrosio L et al (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99:147–155PubMedCrossRefGoogle Scholar
  26. 26.
    Siddiqui T, MacDonald A, Chong PS, Jenkins JT (2008) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg 195:40–47PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Amanda Johner
    • 1
  • Adam Raymakers
    • 1
  • Sam M. Wiseman
    • 1
    Email author
  1. 1.Department of SurgerySt. Paul’s Hospital and The University of British ColumbiaVancouverCanada

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