Estimation of the cost savings resulting from the use of ursodiol for the prevention of gallstones in obese patients undergoing rapid weight reduction

Abstract

BACKGROUND: Morbidly obese patients enrolled in a rapid weight reduction program are at a high risk of developing gallstones. Two multicenter, placebo-controlled, randomized, double-blind trials have demonstrated that the prophylactic use of ursodiol in males and femals 18 to 70 years of age is effective for the prevention of gallstone formation in this patient population. This study examines the cost consequences associated with the prophylactic use of ursodiol. METHODS: A medical decision analysis model for the prophylactic administration of ursodiol in morbidly obese patients undergoing rapid weight reduction by either gastric bypass surgery or very-low-calorie-diet, was developed through the use of data from two clinical trials and review of the related literature. The expert opinion of clinicians from the ®elds of internal medicine, gastroenterology and surgery were solicited. Financial data for the charges associated with cholecystectomies, physician fees and ursodiol were obtained from current ®nancial databases. RESULTS: The model demonstrates that the prophylactic administration of ursodiol, in morbidly obese patients undergoing rapid weight reduction, results in cost savings. Sensitivity analysis was performed to illustrate that the cost savings achieved by the prophylactic use of ursodiol were valid over a realistic range of charges and assumptions. CONCLUSION: The decision model may allow health care decision makers to apply their own data to the model to determine the cost savings obtainable through the prophylactic use of ursodiol in patients undergoing rapid weight reduction.

Almost Routine Prophylactic Cholecystectomy During Laparoscopic Gastric Bypass is Safe

“…UDA is also effective with low-calorie diet [23]. Compliance may be limited, but the drug has been shown to be cost-effective [24,25].…”

EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones

“…Indeed, treatment efficacy is best during the period of weight loss, since the risk of developing stones decreases once the weight has stabilized [150]. A decision tree analysis shows that gallstone prevention with UDCA lowers costs [165]. UDCA has become the standard prophylactic treatment for cholesterol cholelithiasis in obese patients following very-low-calorie diets or after bariatric surgery.…”

Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass

“…For patients without gallstones at the time of operation, ursodiol (Actigall; Ciba-Geigy, Summit, NJ, USA) has been shown to be cost-effective in preventing postoperative gallstone formation [26]. In a multicenter, placebo-controlled, randomized double-blind trial, a 6-month course of treatment lowered the incidence of gallstones from 32% to 2% after open Roux-en-Y gastric bypass with IOUS screening [28].…”