[A clinical decision analysis to assess therapeutic modalities for symptomatic gallstones with respect to patient's quality of life and cost-effectiveness].
A clinical decision analysis was performed to assess new therapeutic modalities for symptomatic gallstones with respect to patient's quality of life (QOL) and cost-effectiveness. A decision tree-based state transition model (Markov approach) implemented to simulate a five-year period of follow-up was constructed. Non-surgical treatments were superior to surgery in enhancing patient's QOL. This advantage was dependent upon the efficacy of non-surgical treatments (stone clearance rate) and patient's age. The optimal candidates were patients with a single radiolucent stone less than 2 cm in diameter for extracorporeal shock-wave lithotripsy (ESWL), and patients with multiple floating stones for oral dissolution, respectively, especially in the elderly. ESWL was less cost-effective than laparoscopic cholecystectomy (LC). ESWL was superior to LC in enhancing patient's utility, but more expensive than LC. LC was economically cost-effective and superior to open cholecystectomy in enhancing patient's QOL for all eligible patients. LC appears to be the therapeutic modality of first choice for the majority of patients with symptomatic gallstones. In conclusion, the results of our analysis suggest the followings. Non-surgical treatments have an advantage over surgery in enhancing patient's QOL and are acceptable alternatives to surgery on the basis of their optimal indications and laparoscopic cholecystectomy is the new standard therapeutic modality in the treatment of symptomatic gallbladder stones.
Habu
Y
Y
Department of Preventive Medicine, Kyoto Prefectural University of Medicine.
Matsui
T
T
Hayashi
K
K
Watanabe
Y
Y
Kawai
K
K
D000368:Aged; D002763:Cholecystectomy / Q000191:economics; D002769:Cholelithiasis / Q000534:rehabilitation / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011336:Probability; D011788:Quality of Life