Faculty Collaboration Database

Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones. J Am Coll Surg 2011 Jun;212(6):1049-1060.e1-7

Date

03/30/2011

Pubmed ID

21444220

Pubmed Central ID

PMC3163150

DOI

10.1016/j.jamcollsurg.2011.02.017

Scopus ID

2-s2.0-79957581433 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

BACKGROUND: Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stones.

STUDY DESIGN: Our decision model included 5 treatment strategies: laparoscopic cholecystectomy (LC) alone followed by expectant management; preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC; LC with intraoperative cholangiography (IOC) ± common bile duct exploration (CBDE); LC followed by postoperative ERCP; and LC with IOC ± postoperative ERCP. The rates of successful completion of diagnostic testing and therapeutic intervention, test characteristics (sensitivity and specificity), morbidity, and mortality for all procedures are from current literature. Hospitalization costs and lengths of stay are from the 2006 National Centers for Medicare and Medicaid Services data. The probability of CBD stones was varied from 0% to 100% and the most cost-effective strategy was determined at each probability.

RESULTS: Across the CBD stone probability range of 4% to 100%, LC with IOC ± ERCP was the most cost-effective. If the probability was 0%, LC alone was the most cost-effective. Our model was sensitive to 1 health input: specificity of IOC, and 3 costs: cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE, and cost of LC with IOC.

CONCLUSIONS: The most cost-effective treatment strategy for the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If stones are detected, CBDE should be forgone and the patient referred for ERCP.

Author List

Brown LM, Rogers SJ, Cello JP, Brasel KJ, Inadomi JM

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy, Laparoscopic
Cholelithiasis
Cost Control
Cost-Benefit Analysis
Decision Support Techniques
Endosonography
Female
Gallstones
Humans
Intraoperative Period
Length of Stay
Male
Middle Aged
Postoperative Period
Preoperative Period
Sensitivity and Specificity
Treatment Outcome
United States
Watchful Waiting