Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost

A Model-Based Cost-Utility Analysis

Charles De Mestral, Jeffrey S Hoch, Andreas Laupacis, Harindra C. Wijeysundera, Ori D. Rotstein, Aziz S. Alali, Avery B. Nathens

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background The application of early cholecystectomy for acute cholecystitis remains inconsistent across hospitals worldwide. Given the constrained nature of health care spending, careful consideration of costs relative to the clinical consequences of alternative treatments should support decision making. We present a cost-utility analysis comparing alternative time frames of cholecystectomy for acute cholecystitis. Study Design A Markov model with a 5-year time horizon was developed to compare costs and quality-adjusted life-years (QALY) gained from 3 alternative management strategies for the treatment of acute cholecystitis: early cholecystectomy (within 7 days of presentation), delayed elective cholecystectomy (8 to 12 weeks from presentation), and watchful waiting, where cholecystectomy is performed urgently only if recurrent symptoms arise. Model inputs were selected to reflect patients with uncomplicated acute cholecystitis - without concurrent common bile duct obstruction, pancreatitis, or severe sepsis. Real-world outcome probability and cost estimates included in the model were derived from analysis of population-based administrative databases for the province of Ontario, Canada. The QALY values were derived from utilities identified in published literature. Parameter uncertainty was evaluated through probabilistic sensitivity analyses. Results Early cholecystectomy was less costly (C$6,905 per person) and more effective (4.20 QALYs per person) than delayed cholecystectomy (C$8,511; 4.18 QALYs per person) or watchful waiting (C$7,274; 3.99 QALYs per person). Probabilistic sensitivity analysis showed early cholecystectomy was the preferred management in 72% of model iterations, given a cost-effectiveness threshold of C$50,000 per QALY. Conclusions This cost-utility analysis suggests early cholecystectomy is the optimal management of uncomplicated acute cholecystitis. Furthermore, deferring surgery until recurrent symptoms arise is associated with the worst clinical outcomes.

Original languageEnglish (US)
Pages (from-to)185-194
Number of pages10
JournalJournal of the American College of Surgeons
Volume222
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Acute Cholecystitis
Cholecystectomy
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Watchful Waiting
Cholestasis
Common Bile Duct
Ontario
Pancreatitis
Uncertainty
Canada
Sepsis
Decision Making
Databases
Delivery of Health Care

ASJC Scopus subject areas

  • Surgery

Cite this

Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost : A Model-Based Cost-Utility Analysis. / De Mestral, Charles; Hoch, Jeffrey S; Laupacis, Andreas; Wijeysundera, Harindra C.; Rotstein, Ori D.; Alali, Aziz S.; Nathens, Avery B.

In: Journal of the American College of Surgeons, Vol. 222, No. 2, 01.02.2016, p. 185-194.

Research output: Contribution to journalArticle

De Mestral, Charles ; Hoch, Jeffrey S ; Laupacis, Andreas ; Wijeysundera, Harindra C. ; Rotstein, Ori D. ; Alali, Aziz S. ; Nathens, Avery B. / Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost : A Model-Based Cost-Utility Analysis. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 2. pp. 185-194.
@article{cbd544eacd064eaa9fb2798ed366dd5f,
title = "Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost: A Model-Based Cost-Utility Analysis",
abstract = "Background The application of early cholecystectomy for acute cholecystitis remains inconsistent across hospitals worldwide. Given the constrained nature of health care spending, careful consideration of costs relative to the clinical consequences of alternative treatments should support decision making. We present a cost-utility analysis comparing alternative time frames of cholecystectomy for acute cholecystitis. Study Design A Markov model with a 5-year time horizon was developed to compare costs and quality-adjusted life-years (QALY) gained from 3 alternative management strategies for the treatment of acute cholecystitis: early cholecystectomy (within 7 days of presentation), delayed elective cholecystectomy (8 to 12 weeks from presentation), and watchful waiting, where cholecystectomy is performed urgently only if recurrent symptoms arise. Model inputs were selected to reflect patients with uncomplicated acute cholecystitis - without concurrent common bile duct obstruction, pancreatitis, or severe sepsis. Real-world outcome probability and cost estimates included in the model were derived from analysis of population-based administrative databases for the province of Ontario, Canada. The QALY values were derived from utilities identified in published literature. Parameter uncertainty was evaluated through probabilistic sensitivity analyses. Results Early cholecystectomy was less costly (C$6,905 per person) and more effective (4.20 QALYs per person) than delayed cholecystectomy (C$8,511; 4.18 QALYs per person) or watchful waiting (C$7,274; 3.99 QALYs per person). Probabilistic sensitivity analysis showed early cholecystectomy was the preferred management in 72{\%} of model iterations, given a cost-effectiveness threshold of C$50,000 per QALY. Conclusions This cost-utility analysis suggests early cholecystectomy is the optimal management of uncomplicated acute cholecystitis. Furthermore, deferring surgery until recurrent symptoms arise is associated with the worst clinical outcomes.",
author = "{De Mestral}, Charles and Hoch, {Jeffrey S} and Andreas Laupacis and Wijeysundera, {Harindra C.} and Rotstein, {Ori D.} and Alali, {Aziz S.} and Nathens, {Avery B.}",
year = "2016",
month = "2",
day = "1",
doi = "10.1016/j.jamcollsurg.2015.10.015",
language = "English (US)",
volume = "222",
pages = "185--194",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost

T2 - A Model-Based Cost-Utility Analysis

AU - De Mestral, Charles

AU - Hoch, Jeffrey S

AU - Laupacis, Andreas

AU - Wijeysundera, Harindra C.

AU - Rotstein, Ori D.

AU - Alali, Aziz S.

AU - Nathens, Avery B.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background The application of early cholecystectomy for acute cholecystitis remains inconsistent across hospitals worldwide. Given the constrained nature of health care spending, careful consideration of costs relative to the clinical consequences of alternative treatments should support decision making. We present a cost-utility analysis comparing alternative time frames of cholecystectomy for acute cholecystitis. Study Design A Markov model with a 5-year time horizon was developed to compare costs and quality-adjusted life-years (QALY) gained from 3 alternative management strategies for the treatment of acute cholecystitis: early cholecystectomy (within 7 days of presentation), delayed elective cholecystectomy (8 to 12 weeks from presentation), and watchful waiting, where cholecystectomy is performed urgently only if recurrent symptoms arise. Model inputs were selected to reflect patients with uncomplicated acute cholecystitis - without concurrent common bile duct obstruction, pancreatitis, or severe sepsis. Real-world outcome probability and cost estimates included in the model were derived from analysis of population-based administrative databases for the province of Ontario, Canada. The QALY values were derived from utilities identified in published literature. Parameter uncertainty was evaluated through probabilistic sensitivity analyses. Results Early cholecystectomy was less costly (C$6,905 per person) and more effective (4.20 QALYs per person) than delayed cholecystectomy (C$8,511; 4.18 QALYs per person) or watchful waiting (C$7,274; 3.99 QALYs per person). Probabilistic sensitivity analysis showed early cholecystectomy was the preferred management in 72% of model iterations, given a cost-effectiveness threshold of C$50,000 per QALY. Conclusions This cost-utility analysis suggests early cholecystectomy is the optimal management of uncomplicated acute cholecystitis. Furthermore, deferring surgery until recurrent symptoms arise is associated with the worst clinical outcomes.

AB - Background The application of early cholecystectomy for acute cholecystitis remains inconsistent across hospitals worldwide. Given the constrained nature of health care spending, careful consideration of costs relative to the clinical consequences of alternative treatments should support decision making. We present a cost-utility analysis comparing alternative time frames of cholecystectomy for acute cholecystitis. Study Design A Markov model with a 5-year time horizon was developed to compare costs and quality-adjusted life-years (QALY) gained from 3 alternative management strategies for the treatment of acute cholecystitis: early cholecystectomy (within 7 days of presentation), delayed elective cholecystectomy (8 to 12 weeks from presentation), and watchful waiting, where cholecystectomy is performed urgently only if recurrent symptoms arise. Model inputs were selected to reflect patients with uncomplicated acute cholecystitis - without concurrent common bile duct obstruction, pancreatitis, or severe sepsis. Real-world outcome probability and cost estimates included in the model were derived from analysis of population-based administrative databases for the province of Ontario, Canada. The QALY values were derived from utilities identified in published literature. Parameter uncertainty was evaluated through probabilistic sensitivity analyses. Results Early cholecystectomy was less costly (C$6,905 per person) and more effective (4.20 QALYs per person) than delayed cholecystectomy (C$8,511; 4.18 QALYs per person) or watchful waiting (C$7,274; 3.99 QALYs per person). Probabilistic sensitivity analysis showed early cholecystectomy was the preferred management in 72% of model iterations, given a cost-effectiveness threshold of C$50,000 per QALY. Conclusions This cost-utility analysis suggests early cholecystectomy is the optimal management of uncomplicated acute cholecystitis. Furthermore, deferring surgery until recurrent symptoms arise is associated with the worst clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84959468846&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959468846&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2015.10.015

DO - 10.1016/j.jamcollsurg.2015.10.015

M3 - Article

VL - 222

SP - 185

EP - 194

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -