Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

Research output: Contribution to journalArticle

Authors

  • A J Sutton
  • R S Vohra
  • M Hollyman
  • P J Marriott
  • A Buja
  • Derek Alderson
  • S Pasquali
  • E A Griffiths
  • CholeS Study Group and the West Midlands Research Collaborative

Colleges, School and Institutes

External organisations

  • University of Leeds
  • Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK.
  • West Midlands Surgical Research Collaborative, Birmingham, UK.
  • Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua.
  • Academic Department of Surgery, University of Birmingham, Birmingham B15 2TH, UK.
  • Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
  • Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK.

Abstract

BACKGROUND: The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease.

METHODS: Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model.

RESULTS: Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0-120 000).

CONCLUSION: Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Bibliographic note

D Mirza, University Hospitals Birmingham NHS Foundation Trust (Liver) is one of the authors

Details

Original languageEnglish
Pages (from-to)98-107
Number of pages10
JournalBritish Journal of Surgery
Volume104
Issue number1
Early online date21 Dec 2016
Publication statusPublished - 1 Jan 2017

Keywords

  • Cholecystectomy, Laparoscopic, Cholecystitis, Acute, Cost-Benefit Analysis, Emergencies, Humans, Models, Economic, Quality-Adjusted Life Years, State Medicine, Time-to-Treatment, United Kingdom, Comparative Study, Journal Article