title: Cost-effectiveness of a new strategy to identify uncomplicated gallstone disease patients that will benefit from a cholecystectomy.
abstract: The aim of this study was to determine the cost-effectiveness of a new strategy for the preoperative detection of patients that will likely benefit from a cholecystectomy, using simple criteria that can be applied by surgeons. Criteria for a cholecystectomy indication are: (1) having episodic pain; (2) onset of pain 1 year or less before the outpatient clinic visit.
  
  
  
  The cost-effectiveness of the new strategy was evaluated against current practice using a decision analytic model. The incremental cost-effectiveness of applying criteria for a cholecystectomy for a patient with abdominal pain and gallstones was compared to applying no criteria. The incremental cost-effectiveness ratio (ICER) was expressed as extra costs to be invested to gain one more patient with absence of pain. Scenarios were analyzed to assess the influence of applying different criteria.
  
  
  
  The new strategy of applying one out of two criteria resulted in a 4 % higher mean proportion of patients with absence of pain compared to current practice with similar costs. The 95 % upper limit of the ICER was €4114 ($4633) per extra patient with relief of upper abdominal pain. Application of two out of two criteria resulted in a 3 % lower mean proportion of patients with absence of pain with lower costs.
  
  
  
  The new strategy of using one out of two strict selection criteria may be an effective but also a cost-effective method to reduce the proportion of patients with pain after cholecystectomy.
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, Nijmegen, The Netherlands. Marklamberts@hotmail.com.|Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Marklamberts@hotmail.com.|Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands. Marklamberts@hotmail.com.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Lamberts
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Cihan
authors.initials: C
authors.lastname: Özdemir
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, Nijmegen, The Netherlands.
authors.forename: Joost P H
authors.initials: JPH
authors.lastname: Drenth
authors.affiliation: Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Cornelis J H M
authors.initials: CJHM
authors.lastname: van Laarhoven
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000328:Adult; D002763:Cholecystectomy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057832:Watchful Waiting
keywords: Cholecystectomy; Cost-effectiveness; Gallstone; ICER; Watchful waiting