Gurusamy, K;
Wilson, E;
Burroughs, AK;
Davidson, BR;
(2012)
Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones: cost-utility and value-of-information analysis.
Appl Health Econ Health Policy
, 10
(1)
pp. 15-29.
10.2165/11594950-000000000-00000.
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.
| Type: | Article |
|---|---|
| Title: | Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones: cost-utility and value-of-information analysis. |
| Location: | New Zealand |
| DOI: | 10.2165/11594950-000000000-00000 |
| Keywords: | Biliary Tract, Biliary Tract Surgical Procedures, Cost-Benefit Analysis, Gallstones, Humans, Intraoperative Care, Preoperative Care, Quality of Life, Sphincterotomy, Endoscopic, State Medicine, United Kingdom |
| URI: | http://discovery.ucl.ac.uk/id/eprint/1331683 |
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