Journal
ANNALS OF SURGERY
Volume 276, Issue 2, Pages E93-E101Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000004532
Keywords
cholecystolithiasis; cost-effectiveness analysis; incremental cost-effectiveness ratio; randomized controlled trial
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Funding
- Netherlands Organization for Health Research and Development, and CZ healthcare insurance
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A restrictive strategy for cholecystectomy in patients with gallstones and abdominal pain significantly reduces the rate of surgery and surgical costs, resulting in savings from a societal perspective. However, it may lead to fewer pain-free patients.
Objective: To perform a cost-effectiveness analysis of restrictive strategy versus usual care in patients with gallstones and abdominal pain. Summary of Background Data: A restrictive selection strategy for surgery in patients with gallstones reduces cholecystectomies, but the impact on overall costs and cost-effectiveness is unknown. Methods: Data of a multicentre, randomized-controlled trial (SECURE-trial) were used. Adult patients with gallstones and abdominal pain were included. Restrictive strategy was economically evaluated against usual care from a societal perspective. Hospital-use of resources was gathered with case-report forms and out-of-hospital consultations, out-of-pocket expenses, and productivity loss were collected with questionnaires. National unit costing was applied. The primary outcome was the cost per pain-free patient after 12 months. Results: All 1067 randomized patients (49.0 years, 73.7% females) were included. After 12 months, 56.2% of patients were pain-free in restrictive strategy versus 59.8% after usual care. The restrictive strategy significantly reduced the cholecystectomy rate with 7.7% and reduced surgical costs with euro160 per patient, euro162 was saved from a societal perspective. The cost-effectiveness plane showed that restrictive strategy was cost saving in 89.1%, but resulted in less pain-free patients in 88.5%. Overall, the restrictive strategy saved euro4563 from a societal perspective per pain-free patient lost. Conclusions: A restrictive selection strategy for cholecystectomy saves euro162 compared to usual care, but results in fewer pain-free patients. The incremental cost per pain-free patient are savings of euro4563 per pain-free patient lost. The higher societal willingness to pay for 1 extra pain-free patient, the lower the probability that the restrictive strategy will be cost-effective.
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