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Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones

Cost-utility and value-of-information analysis

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Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown.

Objective

The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective.

Methods

A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated.

Results

IOES was less costly than POES (approximately −£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million.

Conclusions

IOES appears to be cost effective compared with POES.

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Acknowledgements

No sources of funding were used to conduct this study or prepare this manuscript. The authors have not conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus UCL Medical School, London, UK

    Kurinchi Gurusamy & Brian R. Davidson

  2. Health Economics Group, Faculty of Health, University of East Anglia, Norwich, UK

    Edward Wilson

  3. The Liver Unit, The Royal Free Hospital, London, UK

    Andrew K. Burroughs

  4. C/O Professor B.R. Davidson, 9th Floor, University Department of Surgery, Royal Free Hospital, Pond’s Street, London, NW3 2QG, UK

    Kurinchi Gurusamy

Authors
  1. Kurinchi Gurusamy
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  2. Edward Wilson
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  4. Brian R. Davidson
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Correspondence to Kurinchi Gurusamy.

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Gurusamy, K., Wilson, E., Burroughs, A.K. et al. Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones. Appl Health Econ Health Policy 10, 15–29 (2012). https://doi.org/10.2165/11594950-000000000-00000

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