Cost-Effective Decisions in Detecting Silent Common Bile Duct Gallstones During Laparoscopic Cholecystectomy
| Autor: | Afif N. Kulaylat, Susie X. Sun, Christopher S. Hollenbeak, David I. Soybel |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness medicine.medical_treatment Intraoperative ultrasonography 03 medical and health sciences 0302 clinical medicine Cholangiography medicine Laparoscopic cholecystectomy medicine.diagnostic_test Third party Common bile duct business.industry General surgery Gallstones medicine.disease Diagnostic strategy Quality-adjusted life year medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Cholecystectomy Radiology business Watchful waiting Decision analysis |
| Zdroj: | Journal of the American College of Surgeons. 221:S67 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2015.07.148 |
| Popis: | OBJECTIVE To evaluate the cost-effectiveness of routine intraoperative ultrasonography (IOUS), cholangiography (IOC), or expectant management without imaging (EM) for investigation of clinically silent common bile duct (CBD) stones during laparoscopic cholecystectomy. BACKGROUND The optimal algorithm for the evaluation of clinically silent CBD stones during routine cholecystectomy is unclear. METHODS A decision tree model of CBD exploration was developed to determine the optimal diagnostic approach based on preoperative probability of choledocholithiasis. The model was parameterized with meta-analyses of previously published studies. The primary outcome was incremental cost per quality-adjusted life year (QALY) gained from each diagnostic strategy. A secondary outcome was the percentage of missed stones. Costs were from the perspective of the third party payer and sensitivity analyses were performed on all model parameters. RESULTS In the base case analysis with a prevalence of stones of 9%, IOUS was the optimal strategy, yielding more QALYs (0.9858 vs 0.9825) at a lower expected cost ($311 vs $574) than EM. IOC yielded more QALYs than EM in the base case (0.9854) but at a much higher cost ($1122). IOUS remained dominant as long as the preoperative probability of stones was above 3%; EM was the optimal strategy if the probability was less than 3%. The percentage of missed stones was 1.5% for IOUS, 1.8% for IOC and 9% for EM. CONCLUSIONS In the detection and resultant management of CBD stones for the majority of patients undergoing laparoscopic cholecystectomy, IOUS is cost-effective relative to IOC and EM. |
| Databáze: | OpenAIRE |
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