A cost-effectiveness analysis of intraoperative cholangiography in the prevention of bile duct injury during laparoscopic cholecystectomy.
BACKGROUND
Recent population-based studies have demonstrated that the use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is associated with a decrease in the rate of common bile duct (CBD) injury. The cost implications of a management strategy involving routine IOC use have not been adequately evaluated.


METHODS
Decision analytic models were developed to analyze costs and benefits of routine IOC use during LC. The models were used to calculate the cost per life saved, cost per CBD injury avoided, and incremental cost of IOC when used routinely. Transition probabilities, costs, and outcomes were derived from published sources. Sensitivity analyses were used to account for uncertainty in these estimates.


RESULTS
Using base-case estimates, management of patients undergoing LC with routine IOC would cost 100 dollars more per LC. Routine IOC would prevent 2.5 deaths for every 10,000 patients at a cost of 390,000 dollars per life saved (13,900 dollars per life year saved). The cost per CBD injury avoided with IOC use is 87,143 dollars. The cost per CBD injury avoided is less for procedures done in high-risk patients (approximately 8,000 dollars) or by less experienced surgeons (approximately 61,000 dollars).


CONCLUSIONS
These models describe settings where the cost of IOC and the reduction in CBD injury rates make routine IOC use cost effective. Routine IOC use among less experienced surgeons and in high-risk operations is the most cost effective, but the cost implications of routine use for the general population should also be considered cost effective.
Flum
David R
DR
Robert Wood Johnson Clinical Scholars Program, Department of Surgery, University of Washington, Seattle, WA 98195-7183, USA.
Flowers
Christopher
C
Veenstra
David L
DL
D001649:Bile Duct Diseases / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D001662:Biliary Tract Surgical Procedures / Q000191:economics; D002758:Cholangiography / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D006801:Humans; D016343:Monitoring, Intraoperative / Q000191:economics* / Q000379:methods; D017063:Outcome Assessment, Health Care; D014481:United States