Cost-effectiveness of cholecystectomy compared to conservative management in people presenting with uncomplicated symptomatic gallstones or cholecystitis in India

ObjectivesGallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India.MethodsA decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties.ResultsELC and DLC, compared to CM, incurred an incremental cost of -(sic)10,948 ($146) and (sic)1,054 ($14) for the 0.032 QALYs gained. The ICER was -(sic)3,42,758 ($4577) for ELC vs. CM, and (sic)33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved (sic)12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -(sic)6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses.ConclusionELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.

Automated summary

This study compared the cost-effectiveness of laparoscopic cholecystectomy with conservative management in patients with uncomplicated symptomatic gallstones or cholecystitis in India. The results showed that laparoscopic cholecystectomy is more cost-effective than conservative management, and early laparoscopic cholecystectomy is more cost-effective than delayed laparoscopic cholecystectomy.