Early laparoscopic cholecystectomy is more cost-effective than delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis

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.

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

“…More recent UK economic evaluation by Kerwat et al (100) found early laparoscopy was on average £645 cheaper per patient and could save the NHS £27million per annum if implemented as standard practice. The discrepancy between estimated NHS savings between studies is likely due to differences in NHS reference costings when the studies were published (2018 vs. 2010).…”

Comparison of Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: Experience From Two Centers in Basrah

“…open surgery for gall stone disease and the preferred approach of acute cholecystitis is early rather than delayed one in fit patients 6,7 . This will obviate the consequences of delaying surgery in term of recurrent attacks and absence from work and increase in total expenses, on the reverse some studies proved that early surgery is cost effective [9][10][11] .…”

Quality-of-life after cholecystectomy in Kazakhstan and Sweden: comparative study based on the GIQLI questionnaire

“…Most previous studies on QoL after GSD surgery have concerned surgical approach [12][13][14][15][16] , patient-related factors 4,7 , or timing of the procedure [17][18][19] . Studies on the impact of cultural differences on QoL of patients with pathologies other than GSD have been performed [20][21][22][23] .…”