Abstract
BackgroundThis economic evaluation quantifies the cost-effectiveness of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in the management of acute cholecystitis. The two interventions were assessed in terms of outcome measures, including utilities, to derive quality-adjusted life years (QALYs) as a unit of effectiveness. This study hypothesizes that ELC is more cost-effective than DLC.Materials and methodsIn this economic evaluation, existing literature was compiled and analyzed to estimate the incremental cost-effectiveness of ELC versus DLC. Six randomized controlled trials were used to schematically represent the probabilities of each decision tree branch. To calculate health outcomes, quality of life scores were sourced from three articles and multiplied by the expected length of life postintervention to give QALYs. From an National Health Service (NHS) perspective, one QALY may be sacrificed if the incremental cost-effectiveness ratio is above £20,000–£30,0000 in cost savings.ResultsThis economic evaluation calculated the average net present values of ELC to be £3920 and DLC to be £4565, demonstrating that ELC is the less-expensive intervention, with potential cost savings of £645 per operation. When scaling these savings up to a population approximately comparable to the size of the UK, full-scale implementation of ELC rather than DLC will potentially save the NHS £30,000,000 per annum.ConclusionELCs are cost-effective from the perspective of the NHS. As such, policy should review existing guidelines and consider the merits of ELC versus DLC, improving resource allocation. The findings of this article advocate that ELC should become a standard practice.
Highlights
Cholecystectomy is the recommended treatment for acute cholecystitis for over a century and forms a substantial portion of a typical general surgeons’ workload in developed countries.[1]
The hypothesis of this study is to evaluate whether early laparoscopic cholecystectomy (ELC) is most cost-effective compared to delayed laparoscopic cholecystectomy (DLC) in the treatment of acute cholecystitis
The Incremental costeffectiveness ratio (ICER) calculated in this analysis for ELC versus DLC was £52,051/quality-adjusted life years (QALYs), exceeding the willingness-to-accept threshold of £30,000/QALY sacrificed
Summary
Cholecystectomy is the recommended treatment for acute cholecystitis for over a century and forms a substantial portion of a typical general surgeons’ workload in developed countries.[1]. The introduction of laparoscopic cholecystectomies in 1987 challenged existing norms regarding best practice of laparoscopic cholecystectomy.[5] There was an erroneous fear that operating immediately on inflammatory tissue may lead to an increased risk of complications, thereby rendering ELC a contraindication to acute cholecystitis.[6] more recent evidence suggests that ELC does not, carry a higher risk of morbidity or mortality.[5]. This economic evaluation quantifies the cost-effectiveness of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in the management of acute cholecystitis.
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