Sa1429 THE IMPACT OF ENDOSCOPIC ULTRASOUND GUIDED GALLBLADDER DRAINAGE (EUS-GBD) ON REDUCING COSTS OF REINTERVENTION AND UNPLANNED READMISSION: A BUDGET IMPACT ANALYSIS

Abstract

Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) was introduced as an alternative approach for internally draining the gallbladder in patients with acute cholecystitis at high-risk for surgery. A recent randomized controlled trial showed that EUS-GBD could improve the outcomes when compared with percutaneous cholecystostomy (PT-GBD) in patients with acute cholecystitis who are at high-risk for cholecystectomy (DRAC Trial)( ClinicalTrials.gov Identifier: NCT02212717). We evaluated the economic impact of using EUS-GBD in the public hospitals in Hong Kong via a pilot budget impact analysis. A Microsoft Excel-based budget impact model was developed to estimate the cost of EUS-GBD versus PT-GBD. The model was used to measure the costs in terms of total cost in a year for all the patients admitted to all public hospitals in Hong Kong. The admission data from the patients were collected from the records in the previous randomized controlled trial (DRAC Trial). The cost information including screening cost (cost before interventions), procedural costs, potential re-intervention costs, costs for regular follow-up, costs of unplanned readmissions, and total costs of medications was collected from published literature, the Clinical Data Analysis and Reporting System (CDARS) of the Hospital Authority, and price lists from different local hospitals/clinics. According to the statistics of patients having acute cholecystitis with PT inserted in 2018 in Hong Kong, a hypothetical population size of 400 was assumed. As it is a budget impact analysis for a short time horizon of one year, there was no discounting of costs. According to the budget impact analysis, the total average cost per patient receiving EUS-GBD was around HK$127,096, while the total average cost per patient receiving PT-GBD [MW1] was around HK$88,576, representing an incremental healthcare costs of HK$15.4M for all local patients in a year. The EUS-GBD would reduce the expected cost for re-intervention (HK$1,406 vs HK$12,492), whereas it would also decrease the expected cost from unplanned readmissions (HK$3,510 vs HK$13,397) when compared with PT-GBD. Nevertheless, the procedural cost of EUS-GBD is higher than that of PT-GBD. The findings of this study demonstrated that EUS-GBD could save the cost for re-intervention and unplanned readmissions. This could potentially enhance patients' quality of life after EUS-GBD. Future prospective studies are warranted to compare the quality adjusted life years between patients who received EUS-GBD and PT-GBD.