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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.

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.

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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, Great Britain, Humans, Intraoperative Care, Preoperative Care, Quality of Life, Sphincterotomy, Endoscopic, State Medicine
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of) > Research Department of General Surgery
URI: http://discovery.ucl.ac.uk/id/eprint/1331683
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