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Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

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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.

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Disclosures

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

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Authors and Affiliations

  1. Department of Surgery, St. Paul’s Hospital and The University of British Columbia, Burrard Building, Room C-303, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Amanda Johner, Adam Raymakers & Sam M. Wiseman

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  1. Amanda Johner
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  2. Adam Raymakers
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  3. Sam M. Wiseman
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Correspondence to Sam M. Wiseman.

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Johner, A., Raymakers, A. & Wiseman, S.M. Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 27, 256–262 (2013). https://doi.org/10.1007/s00464-012-2430-1

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  • DOI: https://doi.org/10.1007/s00464-012-2430-1

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