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Cost Effectiveness of Routine Laparoscopic Ultrasound for Assessment of Resectability of Gallbladder Cancer

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In addition to a diagnostic laparoscopy (DL), a routine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) patients planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients.

Methods

Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payer’s perspective), quality-adjusted life weeks (QALWs), and incremental cost-effectiveness ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/QALY).

Results

DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS), resulting in a cost reduction of $9,220 per quality-adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased or the probability of exclusion from resection decreased.

Conclusions

Routine LUS with DL for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in preoperative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Hasan Nadeem, Thejus T. Jayakrishnan MBBS, Ryan T. Groeschl MD, Anthony Zacharias BS, T. Clark Gamblin MD, MS & Kiran K. Turaga MD, MPH

Authors
  1. Hasan Nadeem
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  2. Thejus T. Jayakrishnan MBBS
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  3. Ryan T. Groeschl MD
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  4. Anthony Zacharias BS
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  5. T. Clark Gamblin MD, MS
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  6. Kiran K. Turaga MD, MPH
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Corresponding author

Correspondence to Kiran K. Turaga MD, MPH.

Additional information

Hasan Nadeem and Thejus T Jayakrishnan are first authors.

Appendix

Appendix

See Appendix Tables 3, and 4.

Table 3 Professional and hospital reimbursement based on Medicare data used for calculation of cost from payer’s perspective
Full size table
Table 4 Quality-adjusted life week (QALW) over 6 weeks based on average global function-quality-of-life (GF-QOL) scores using Functional Assessment of Cancer Therapy (FACT) scoring system25–27
Full size table

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Nadeem, H., Jayakrishnan, T.T., Groeschl, R.T. et al. Cost Effectiveness of Routine Laparoscopic Ultrasound for Assessment of Resectability of Gallbladder Cancer. Ann Surg Oncol 21, 2413–2419 (2014). https://doi.org/10.1245/s10434-014-3487-y

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  • DOI: https://doi.org/10.1245/s10434-014-3487-y

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