Cost-effectiveness of Restrictive Strategy Versus Usual Care for Cholecystectomy in Patients With Gallstones and Abdominal Pain (SECURE-trial).

Autor:	Latenstein CSS; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Wennmacker SZ; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., van Dijk AH; Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands., Drenth JPH; Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands., Westert GP; IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands., van Laarhoven CJHM; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Boermeester MA; Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands., de Reuver PR; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Dijkgraaf MGW; Department of Epidemiology and Data Science, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2022 Aug 01; Vol. 276 (2), pp. e93-e101. Date of Electronic Publication: 2020 Oct 15.
DOI:	10.1097/SLA.0000000000004532
Abstrakt:	Objective: To perform a cost-effectiveness analysis of restrictive strategy versus usual care in patients with gallstones and abdominal pain. Summary of Background Data: A restrictive selection strategy for surgery in patients with gallstones reduces cholecystectomies, but the impact on overall costs and cost-effectiveness is unknown. Methods: Data of a multicentre, randomized-controlled trial (SECURE-trial) were used. Adult patients with gallstones and abdominal pain were included. Restrictive strategy was economically evaluated against usual care from a societal perspective. Hospital-use of resources was gathered with case-report forms and out-of-hospital consultations, out-of-pocket expenses, and productivity loss were collected with questionnaires. National unit costing was applied. The primary outcome was the cost per pain-free patient after 12 months. Results: All 1067 randomized patients (49.0 years, 73.7% females) were included. After 12 months, 56.2% of patients were pain-free in restrictive strategy versus 59.8% after usual care. The restrictive strategy significantly reduced the cholecystectomy rate with 7.7% and reduced surgical costs with €160 per patient, €162 was saved from a societal perspective. The cost-effectiveness plane showed that restrictive strategy was cost saving in 89.1%, but resulted in less pain-free patients in 88.5%. Overall, the restrictive strategy saved €4563 from a societal perspective per pain-free patient lost. Conclusions: A restrictive selection strategy for cholecystectomy saves €162 compared to usual care, but results in fewer pain-free patients. The incremental cost per pain-free patient are savings of €4563 per pain-free patient lost. The higher societal willingness to pay for 1 extra pain-free patient, the lower the probability that the restrictive strategy will be cost-effective. Trial Registration: The Netherlands National Trial Register NTR4022. Registered on 5 June 2013. Competing Interests: The authors report no conflicts of interest. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu