title: Cost effectiveness of routine laparoscopic ultrasound for assessment of resectability of gallbladder cancer.
abstract: BACKGROUND
  In addition to a diagnostic laparoscopy (DL), a routine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) patients planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients.
  
  
  METHODS
  Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payer's perspective), quality-adjusted life weeks (QALWs), and incremental cost-effectiveness ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/QALY).
  
  
  RESULTS
  DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS), resulting in a cost reduction of $9,220 per quality-adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased or the probability of exclusion from resection decreased.
  
  
  CONCLUSIONS
  Routine LUS with DL for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in preoperative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Nadeem
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Groeschl
authors.forename: Anthony
authors.initials: A
authors.lastname: Zacharias
authors.forename: T
authors.initials: T
authors.lastname: Clark Gamblin
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D019412:Anatomy, Cross-Sectional; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008390:Markov Chains; D011300:Preoperative Care; D011379:Prognosis; D011788:Quality of Life; D014463:Ultrasonography / Q000191:economics*