Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis
- 659 Downloads
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.
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.
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.
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.
KeywordsAcute cholecystitis Delayed laparoscopic cholecystectomy Early laparoscopic cholecystectomy
Amanda Johner, Adam Raymakers, and Sam M. Wiseman have no conflicts of interest or financial ties to disclose.
- 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.Gurusamy KS, Samraj K (2006) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev (4):CD005440Google Scholar
- 13.The Cost-Effectiveness Analysis Registry (2010) http://www.cearegistry.org. Accessed 21 Feb 2010
- 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