A cost utility analysis of treatment options for gallstone disease: Methodological issues and results

Abstract

The techniques of cost utility analysis (CUA) were used to evaluate the treatment of gallstone disease by open and laparoscopic cholecystectomy and by extracorporeal shockwave lithotripsy (ESWL). The application of the techniques in this context raised three methodological questions which are not satisfactorily resolved in the literature. The first is whether an ex ante or ex post perspective is best adopted for the measurement of quality of life (QoL). The second is the method for converting a short term deterioration in QoL followed by full health into QALYs and the reliability of the methods available. The third is the issue of indirect costs which, in the context of a temporary disease state, cannot be easily avoided. The economic evaluation found laparoscopic cholecystectomy to be generally superior than the competitor technologies (entailing lower costs and better outcomes). However, the results were sensitive to assumptions about the perspective for measuring benefits and the inclusion of indirect costs.

Utilities and disutilities for attributes of injectable treatments for type 2 diabetes

“…Death may not be an effective lower anchor for all health states, however, because participants may be reluctant to gamble with death when the health states describe mild medical conditions. Thus, to discriminate among health states in the high range of the utility scale, it is often necessary to use a temporary health state approach [4,7,[43][44][45][47][48][49][50][51][52]. In this approach, the health states are framed in terms of a specific duration (e.g., 1 month in the current study), with the lower anchor of 0 corresponding to a ''worst'' health state instead of death.…”

Chained time trade-off and standard gamble methods

“…It is possible that this short time frame had an additional effect on the health state values. Cook et al [25]tested the effect of duration on health state values by calculating the values of the reference state using a 12-month and a 12-year time period followed by death. They found no evidence of a significant difference in values.Other research has shown that values are a decreasing function of duration [26].…”

Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation

“…None of these studies compared conservative management with cholecystectomy. There were six papers that compared outcomes of different interventions such as mini laparotomy, lithotripsy, open cholecystectomy with laparoscopic cholecystectomy 116,117,[136][137][138][139] and one paper compared the different methods of valuing health-related QoL techniques, i.e. visual analogue scale and the standard gamble in measuring people preferences for outcomes of gallstone disease.…”

“…Macafee et al 117 compared early with delayed cholecystectomy and reported utility scores of 0.85 (standard deviation 0.26) for the early group and 0.93 (standard deviation 0.13) for the conventional (delayed) group (QALYs estimated using the EQ-5D questionnaire were calculated 30-35 days after laparoscopic surgery). The final study 138 estimated QALYs for different health states relating to two treatment options using a time trade-off method. The utility score for laparoscopic cholecystectomy was found to be similar to those of the Macafee et al…”