Early laparoscopic cholecystectomy is more cost-effective than delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis
Received 24 August 2017
Accepted for publication 14 November 2017
Published 19 February 2018 Volume 2018:10 Pages 119—125
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Dean Smith
Doa’a Kerwat,1 Alexander Zargaran,2 Reshma Bharamgoudar,3 Nadia Arif,4 Grace Bello,2 Bharat Sharma,5 Rajab Kerwat6
1Department of Medicine, Barts and The London, 2Department of Medicine, St George’s University of London, London, 3Department of Medicine, Birmingham University, Birmingham, 4Department of Medicine, Brighton and Sussex Medical School, Brighton, 5Department of Medicine, Imperial College London, 6Department of Medicine, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
Background: This 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 methods: In 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.
Results: This 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.
Conclusion: ELCs 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.
Keywords: economic evaluation, cost-effectiveness analysis, acute cholecystitis, laparoscopic cholecystectomy, NHS, NICE guidelines
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