Cost-effectiveness of early laparoscopic cholecystectomy for mild acute gallstone pancreatitis.
BACKGROUND
A recent Cochrane review suggested that laparoscopic cholecystectomy carried out early following mild gallstone pancreatitis was safe. This study compared the cost-effectiveness of laparoscopic cholecystectomy performed within 3 days of admission, during the same admission but after more than 3 days, or electively in a subsequent admission.


METHODS
A model-based cost-utility analysis was performed estimating mean costs and quality-adjusted life-years (QALYs) per patient in the UK National Health Service with a 1-year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources for mild gallstone pancreatitis, including one-way and probabilistic sensitivity analyses.


RESULTS
The costs of laparoscopic cholecystectomy performed within 3 days of admission, beyond 3 days but in the same admission, and electively in a subsequent admission were € 2748, € 3543 and € 3752 respectively; the QALYs were 0.888, 0.888 and 0.884 respectively. Early laparoscopic cholecystectomy had a 91 per cent probability of being cost-effective at the maximum willingness to pay for a QALY commonly used in the UK. It is acknowledged that many hospitals do not have access to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, especially at weekends, and that implementing a 3-day target is unrealistic without allocating new resources that could erode the cost-effectiveness.


CONCLUSIONS
Performing laparoscopic cholecystectomy for mild gallstone pancreatitis within 3 days of admission is cost-effective, but may not be feasible without significant resource allocation. After 3 days there is little financial advantage to same-admission operation.
Department of Applied Health Research, University College London.
S
S
Morris
K S
KS
Gurusamy
N
N
Patel
B R
BR
Davidson
D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010195:Pancreatitis / Q000601:surgery*; D011336:Probability; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013997:Time Factors; D006113:United Kingdom