A clinical decision analysis to assess the value of laparoscopic cholecystectomy in the treatment of gallstone disease.
Laparoscopic cholecystectomy has been introduced for gallstone therapy and its use appears currently to be spreading very rapidly. A clinical decision analysis was performed to assess this new technique by quantitative comparison with other therapeutic modalities. A decision tree-based state transition model implemented to simulate a five-year period of follow-up was constructed. Non-surgical treatments were superior to surgical treatments in enhancing both life expectancy and quality-adjusted life expectancy on the basis of the optimal indications; one radiolucent stone < 2 cm for extracorporeal shock-wave lithotripsy and multiple floating stones for oral dissolution therapy respectively, especially in the elderly. Laparoscopic cholecystectomy was superior to open cholecystectomy in enhancing the quality of life for all eligible patients. Sensitivity analysis revealed that a higher incidence of the bile duct injury resulting from laparoscopic cholecystectomy would result in a poorer quality-adjusted life expectancy. The results of the analysis suggest the following. Nonsurgical treatments are acceptable alternatives to surgery on the basis of their optimal indications. Laparoscopic cholecystectomy has an advantage over open cholecystectomy in enhancing the patient's utility, and appears to be an attractive therapeutic modality. A proper training program is necessary to ensure the quality of this procedure in order to maintain its advantage.
Habu
Y
Y
Department of Preventive Medicine, Kyoto Prefectural University of Medicine, Japan.
Hayashi
K
K
Watanabe
Y
Y
Kawai
K
K
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery* / Q000628:therapy; D003663:Decision Trees; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies